New antiarrhythmic treatment of atrial fibrillation.
Antiarrhythmic pharmaceutical development for the treatment of atrial fibrillation (AF) is moving in several directions. The efficacy of existing drugs, such as carvedilol, for rate control and, possibly, suppression of AF, is more appreciated. Efforts are being made to modify existing agents, such as amiodarone, in an attempt to ameliorate safety and adverse effect concerns. This has resulted in promising data from the deiodinated amiodarone analog, dronedarone, and further work with celivarone and ATI-2042. In an attempt to minimize ventricular proarrhythmia, atrial selective drugs, such as intravenous vernakalant, have demonstrated efficacy in terminating AF in addition to promising data in suppression recurrences when used orally. Several other atrial selective drugs are being developed by multiple manufacturers. Other novel therapeutic mechanisms, such as drugs that enhance GAP junction conduction, are being developed to achieve more effective drug therapy than is offered by existing compounds. Finally, nonantiarrhythmic drugs, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, high-mobility group coenzyme A enzyme inhibitors and omega-3 fatty acids/fish oil, appear to have a role in suppressing AF in certain patient subtypes. Future studies will clarify the role of these drugs in treating AF.
Naccarelli
Gerald V
GV
Penn State University Heart and Vascular Institute, The Electrophysiology Program, Penn State University College of Medicine, The Milton S. Hershey Medical Center, 500 University Dr., Room H 1.511, Hershey, PA 17033, USA. gnaccarelli@psu.edu
Wolbrette
Deborah L
DL
Samii
Soraya
S
Banchs
Javier E
JE
Penny-Peterson
Erica
E
Gonzalez
Mario D
MD
D000241:Adenosine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D058916:Adenosine A1 Receptor Antagonists; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000638:Amiodarone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001572:Benzofurans / Q000494:pharmacology / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000494:pharmacology / Q000627:therapeutic use; D019086:Bridged Bicyclo Compounds, Heterocyclic / Q000494:pharmacology / Q000627:therapeutic use; D002227:Carbazoles / Q000494:pharmacology / Q000627:therapeutic use; D000077261:Carvedilol; D003521:Cyclopropanes / Q000494:pharmacology / Q000627:therapeutic use; D000077764:Dronedarone; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology / Q000627:therapeutic use; D005663:Furans / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D009842:Oligopeptides / Q000494:pharmacology / Q000627:therapeutic use; D009930:Organic Chemicals / Q000494:pharmacology / Q000627:therapeutic use; D007703:Peptidyl-Dipeptidase A / Q000494:pharmacology / Q000627:therapeutic use; D026902:Potassium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use; D058906:Purinergic P1 Receptor Agonists
C501729:AVE 0118; C514242:AZD 7009; D058916:Adenosine A1 Receptor Antagonists; D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D001572:Benzofurans; D001713:Biphenyl Compounds; D019086:Bridged Bicyclo Compounds, Heterocyclic; D002227:Carbazoles; D003521:Cyclopropanes; D015525:Fatty Acids, Omega-3; D005663:Furans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009842:Oligopeptides; D009930:Organic Chemicals; D026902:Potassium Channel Blockers; D011412:Propanolamines; D058906:Purinergic P1 Receptor Agonists; D000077261:Carvedilol; C522396:selodenoson; C059921:tedisamil; D007703:Peptidyl-Dipeptidase A; C477643:rotigaptide; C118601:tecadenoson; D000077764:Dronedarone; C499879:celivarone; D000241:Adenosine; D000638:Amiodarone