The limited efficacy and safety concerns of current antiarrhythmic drugs for atrial fibrillation highlight the need for novel, atrium-selective agents that prevent electrophysiological remodeling without ventricular proarrhythmic effects.
Existing antiarrhythmics warrant cautious AF use; leaves open priority for atrium-selective agent development.
Although the maintenance of sinus rhythm would be the ideal scenario for patients with atrial fibrillation (AF), recent randomised trials have questioned the value of this approach. A careful interpretation of their results showed the limited efficacy of currently available antiarrhythmic drugs in maintaining sinus rhythm, as well as their potentially serious side effects. Therefore, it is imperative to develop safer and more effective drugs for AF. Based on our improved understanding of the pathophysiology of AF and the mechanism of action of antiarrhythmic drugs, significant efforts are being made to develop new antiarrhythmic agents that would prevent electrophysiological remodelling, would be selective for the atria and, therefore, would not prolong ventricular repolarisation, thus lacking any proarrhythmic effect.
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Vardas et al. (2006) studied this question.
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