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Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Clinical trials

Authors
Kapil Kumar, MD
Peter J Zimetbaum, MD
Section Editor
Bradley P Knight, MD, FACC
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Long-term outcomes, such as survival or rate of thromboembolism, are similar with either rhythm or rate control strategies in patients with atrial fibrillation (AF) (figure 1A-B). In addition, anticoagulation is required with both in most patients [1,2]. Thus, the main goal of therapy is to reduce symptoms by decreasing the frequency and duration of episodes [3,4].

When the rhythm control strategy is chosen, the recommended drugs for maintenance of sinus rhythm vary with the clinical setting (table 1 and algorithm 1) [3,5]. Optimal antiarrhythmic drug therapy should be both effective and have a low incidence of toxicity, including proarrhythmia [6-8].

Most patients for whom rhythm control is chosen will require rate control, both prior to its initiation and after, as many patients will have breakthrough episodes of AF. (See "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy".)

The studies describing the efficacy and toxicity (including proarrhythmia) of the different antiarrhythmic drugs used to maintain sinus rhythm in patients with AF will be reviewed here. Recommendations concerning the use of pharmacologic therapy, the choice between a rhythm and a rate control strategy, and the role of alternative methods to maintain sinus rhythm in selected patients who are refractory to conventional therapy, including surgery and radiofrequency ablation, are discussed separately. (See "Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Recommendations" and "Rhythm control versus rate control in atrial fibrillation" and "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications" and "Surgical ablation to prevent recurrent atrial fibrillation".)

This topic will also address the issue of whether other medications are associated with a decreased frequency of recurrent AF. (See 'Other therapies' below.)

                      

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 21 00:00:00 GMT+00:00 2016.
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