Atrial fibrillation: choosing an antiarrhythmic drug.
Atrial fibrillation is the most common arrhythmia encountered in clinical practice. The associated hemodynamic changes can lead to symptoms of palpitations, fatigue, light-headedness, or dyspnea. Extensive research in the use of antiarrhythmic drugs has been performed both to facilitate the conversion of atrial fibrillation to sinus rhythm and to maintain normal sinus rhythm. The relative merits of a rhythm control versus rate control strategy are briefly discussed. Efficacy of the available agents for pharmacologic cardioversion is reviewed in detail. Important drugs for maintenance of sinus rhythm include amiodarone, flecainide, propafenone, sotalol, and dofetilide. Selection of the appropriate antiarrhythmic drug must be individualized to the clinical situation, with Class IC drugs being first-line agents in the absence of structural heart disease. Regardless of agent selected, appropriate monitoring for development of adverse effects is of utmost importance.
Rudo
Todd
T
Division of Cardiovascular Diseases, Main Line Health Heart Center, Lankenau Hospital, 100 Lancaster Avenue, MOB East, Suite 558, Wynnewood, PA 19096, USA. tjrudo@comcast.net
Kowey
Peter
P
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D004554:Electric Countershock; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans
D000889:Anti-Arrhythmia Agents