Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2008)

The guidelines for pharmacotherapy of arrhythmia in Japan are based on the concepts of the Sicilian Gambit.The Sicilian Gambit is a project that was established to consider optimal antiarrhythmic drug treatment during the period of time when the results of the Cardiac Arrhythmia Suppression Trial (CAST) 1 published in 1989 caused concerns regarding the safety of antiarrhythmic drugs throughout the world.The members of the project hold four meetings during the period from 1990 to 2000.The new concepts developed at the meetings of the Sicilian Gambit have significantly affected the preparation of guidelines in Japan. 2 In April 1996, the Japanese Section of the Sicilian Gambit was established through the support of the Japan Heart Foundation, and initiated its dissemination of the concepts of the Sicilian Gambit.Immediately after the third meeting of the Sicilian Gambit in October 1996, the Japanese Society of Electrocardiology established "the Committee for Guidelines for Antiarrhythmic Drugs".In April 1997, "the Task Force for Preparation of Guidelines for Selection of Antiarrhythmic Drugs according to the Sicilian Gambit" was established and began its activities.The Task Force published a guidelines CD-ROM in 2000, 3 on the basis of which the Guidelines for Pharmacotherapy of Atrial Fibrillation in 2001 4 were created.In Europe and the United States, the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC) jointly published the Guidelines for the Management of Patients with Atrial Fibrillation in 2001, 5 and revised them in 2006.6 These guidelines, however, include little related to the concepts of the Sicilian Gambit.The ACC/AHA/ESC Guidelines highlight evidence-based recommendations, though the logical rationales supplied for selection of antiarrhythmic drugs are