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

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

INTRODUCTION

For patients with atrial fibrillation (AF), there are two main strategies to manage the irregular rhythm and its impact on symptoms: rhythm control (restoration followed by maintenance of sinus rhythm with either antiarrhythmic drugs or catheter ablation); and rate control with atrioventricular (AV) nodal blockers. (See 'Rhythm versus rate control' below.)

For those patients in whom a rhythm control strategy is chosen, the main goal of therapy is to reduce symptoms by decreasing the frequency and duration of episodes as well as the symptoms during recurrences [1,2]. As antiarrhythmic drugs are associated with a potential for serious adverse side effects, particularly the induction of proarrhythmia, they should be prescribed only by practitioners familiar with their use. Patients should be fully informed of both the benefits and risks associated with the use of these drugs. (See 'Drug-related arrhythmias and mortality' below.)

Rhythm control can be achieved with either antiarrhythmic drug therapy or nonpharmacologic methods. This topic provides recommendations for the former. The clinical trials describing the efficacy and toxicity (including proarrhythmia) of the different antiarrhythmic drugs are presented separately. (See "Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Clinical trials".)

Nonpharmacologic methods to maintain sinus rhythm (including surgery and radiofrequency ablation or cryoballoon ablation) in selected patients who are refractory to conventional therapy are discussed elsewhere. (See "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications" and "Surgical ablation to prevent recurrent atrial fibrillation".)

INDICATIONS

There are three settings in which a rhythm control strategy for the maintenance of sinus rhythm should be considered [3]:

                           

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