Reverse Use Dependence

Reverse use dependence is a pharmacological pattern in which a drug produces a greater effect at slower rates of tissue activation, particularly in cardiac electrophysiology. Unlike use-dependent block, the effect strengthens when stimulation frequency falls because drug binding, ion-channel kinetics, or action-potential recovery allows greater channel inhibition during prolonged intervals between activations. This phenomenon is associated with some class III antiarrhythmic drugs, which can prolong cardiac repolarization and the QT interval more prominently at slow heart rates. Recognizing reverse use dependence helps researchers evaluate antiarrhythmic efficacy, understand rate-related adverse effects, and assess the risk of drug-induced torsades de pointes.

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