Considerations for the Development of New Antiarrhythmic Drugs

Several studies over the past few years have investigated the benefits of antiarrhythmic drugs (AADs) for the treatment of atrial fibrillation (AF). Data from key studies comparing rate versus rhythm control show no evidence of superiority in terms of survival benefits with either therapeutic strategy. In terms of AADs, many of the currently available drugs are associated with safety issues, thus the relative risk–benefit ratios of each drug is a major consideration when selecting an AAD in therapy. The safety issues and complications associated with current therapeutic drug options clearly indicate the need for novel drug development in the field of AF. New approaches that have been evaluated include AADs with greater atrial selectivity and novel non-selective multichannelblocking AADs. Trials evaluating new AADs will likely need to demonstrate superior safety profiles over existing drugs. However, in light of the inconclusive results in terms of survival benefits of the major rate versus rhythm studies and the increasing use of nonpharmacological techniques, including direct-current cardioversion and ablative techniques, cardiologists are faced with questions concerning the specific direction of new AAD development to be undertaken in future.