Antiarrhythmic drugs for maintaining of sinus rhythm

The pharmacological strategy to treat atrial fibrillation (AF) has been studied in the last years by a number of randomized studies. The overall results showed that the 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 for recurrent AF is recommended on the basis of choosing safer, although possibly less efficacious drug. Flecainide, propafenone, sotalol and dronedarone are the first-line drugs for patients with a minimal or no heart disease, or hypertension without left ventricular hypertrophy. Sotalol and dronedarone are recommended as first-line drugs for patients with a coronary artery disease. Dronedarone should be considered in order to reduce cardiovascular hospitalizations related to AF/flutter. It can also be used safely in patients with hypertensive heart disease and stable NYHA class I-II heart failure. Amiodarone is the most effective antiarrhythmic in all clinical settings, but because of its toxicity profile should generally be used when other agents have failed or are contraindicated. Amiodarone is recommended as drug of choice in patients with severe heart failure or recently unstable NYHA class II.