Antiarrhythmic drug therapy of atrial fibrillation

The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial suggested that antiarrhythmic therapy did not worsen mortality in patients with atrial fibrillation (AF). However, in many patients antiarrhythmic drugs provide the best symptom relief. For chronic maintenance therapy, drug selection must be patient-specific. In patients with no or minimal structural heart disease, Class IC drugs and sotalol are recommended. In patients with ischemic heart disease, sotalol is preferred, and in patients with cardiac failure or severe left ventricular hypertrophy, amiodarone and dofetilide are preferred. For acute pharmacologic conversion of AF, Class IC drugs and ibutilide are efficacious and safe in patients without severe structural heart disease; in other patients amiodarone is preferred.