Antiarrhythmic drug therapy of atrial fibrillation.
In the post-AFFIRM era, treatment of AF has become the treatment of symptoms. In some patients, this will be simple rate control, but there remain a significant cohort of patients in whom rate control alone does not give acceptable symptom relief. In this group, antiarrhythmic therapy still has a role, and the AFFIRM trial indicates that this therapeutic strategy is without significant deleterious effect on mortality. The choice of antiarrhythmic agent must be individualized according to underlying cardiac pathologies and comorbidities, however. Most recently, the introduction of dofetilide has widened the therapeutic options in patients with severe heart disease, and the Canadian Trial of Atrial Fibrillation indicated the superior efficacy of amiodarone at low doses. The release/ development of newer Class III antiarrhythmic agents may offer hope for the benefits of amiodarone without the serious adverse effects with long-term therapy.
Electrophysiology Laboratory, Cardiovascular Division, Department of Medicine, University of Virginia Health System, Private Clinics Building, Room 5610, Hospital Drive, Charlottesville, VA 22908-0158, USA.
Robert A
RA
VerNooy
J Paul
JP
Mounsey
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004206:Disopyramide / Q000627:therapeutic use; D005424:Flecainide / Q000627:therapeutic use; D006801:Humans; D010627:Phenethylamines / Q000627:therapeutic use; D013015:Sotalol / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; D013015:Sotalol; D004206:Disopyramide; D005424:Flecainide; D000638:Amiodarone; C063533:dofetilide