Review article

Antiarrhythmic drug therapy to treat atrial fibrillation.

Dubravko Petrač ; Bogdan Cardiology Polyclinic, Zagreb, Croatia

Abstract

Over the past 10 years, considerable effort has been made in establishing the role of antiarrhythmic drug therapy for maintenance of sinus rhythm in patients with atrial fibrillation (AF). Data from randomized controlled studies have demonstrated that rhythm control strategy is not superior to the rate control strategy in terms of mortality or stroke, mostly due to limited efficacy and toxicity of antiarrhyhtmic drugs in the rhythm control patients. Regarding to these data, current antiarrhythmic therapy to maintain sinus rhythm in patients with AF is recommended on the basis of choosing safer, although possibly less efficacious drug. The rationale for starting with a trial of antiarrhythmic therapy is that up to 50% of patients may be effectively treated with this approach, and when properly administered, there is little risk to the patient. Accordingly, the choice of antiarrhyhtmic drugs depends on patient characteristics and potential drug toxicity.
In patients with a minimal or no heart disease, or hypertension without left ventricular hypertrophy, dronedarone, flecainide, propafenone, and sotalol may be used for maintaining of sinus rhythm as the first-line drugs. For patients with coronary artery disease without overt heart failure, sotalol is recommended as first-line treatment option, and dronedarone as reasonable alternative. Amiodarone is reserved for those who have failed treatment with other antiarrhythmic drugs or have significant structural heart disease, i.e. heart failure or significant left ventricular hypertrophy.

Keywords

atrial fibrillation; antiarrhyhtmic drugs; dronedarone

Hrčak ID:

94696

URI

https://hrcak.srce.hr/94696

Publication date:

4.12.2012.

Article data in other languages: croatian

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