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Current Role of Medical Therapy for Prevention or Termination of Atrial Fibrillation

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Book cover Atrial Fibrillation

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Antiarrhythmic drug therapy is the mainstay for managing atrial fibrillation (AF). The main limitations of antiarrhythmic drug therapy include limited effi cacy, potential adverse effects, and the palliative nature of this treatment option. Nevertheless, substantial evidence has emerged suggesting that drugs such as angiotensin-converting enzyme inhibitors and angiotensin receptor-blocking agents can reduce the frequency of AF episodes and may even prevent its development. There have been several trials conducted to assess the effi cacy and risks of several antiarrhythmic agents. Amiodarone has clearly been shown to be the most effective in the majority of these trials; however, it is associated with several cardiac and noncardiac adverse effects. Propafenone is considered to be the best-tolerated drug currently available; however, class 1c agents are associated with increased risk of ventricular fi brillation in patients who have survived a myocardial infarction. Sotalol and dofetilide prolong the QT interval and in some patients can cause torsades de pointes. The effi cacy of pharmacological conversion depends on the duration of AF. Dofetilide, flecainide, ibutilide, and profenone are considered fi rst line and amiodarone second line for pharmacological conversion. In trials, dofetilide and ibutilide appear to have the highest rate of conversion to sinus rhythm. In patients with structural heart disease or prolonged QRS duration, dofetilde and amiodarone are the first choice. In the absence of structural heart disease, ibutilde, flecainide, and propafenone can be used. The “ pill-in-the-pocket” approach suggests that patients with new-onset AF should be treated in the emergency room with an oral class 1c agent. Treatment with both flecainide and propafenone was successful in 94% of episodes, the time to resolution of symptoms was 113 ± 84 min, and 7% of patients reported adverse effects. Newer agents, such as dronaderone and azimilide, are still in the investigational stage.

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Author information

Authors and Affiliations

  1. Kingston General Hospital, Queen's University, Kingston, Ontario, Canada

    Adrian Baranchuk

  2. Arrhythmia Service, Cardiology Division, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Carlos A. Morillo

  3. Department of Clinical Pharmacology, Medical Faculty Carl-Gustav Carus, Technical University Dresden,  , Germany

    Martin Thoenes

  4. Department of Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Rodolpho Ventura

  5. McMaster University, Hamilton, Ontario, Canada

    Stuart J. Connolly (Professor of Medicine, Director of Cardiology)

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  1. Adrian Baranchuk
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  2. Carlos A. Morillo
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  3. Martin Thoenes
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  4. Rodolpho Ventura
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  5. Stuart J. Connolly
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Editors and Affiliations

  1. Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA

    Andrea Natale MD (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor) (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor)

  2. Division of Cardiology, Stanford University, Palo Alto, CA, USA

    Andrea Natale MD (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor) (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor)

  3. University of Michigan, Ann Arbor, MI, USA

    José Jalife MD (Professor of Internal Medicine, The Cyrus and Jane Farrehi Professor of Cardiovascular Research, Professor of Molecular and Integrative Physiology) (Professor of Internal Medicine, The Cyrus and Jane Farrehi Professor of Cardiovascular Research, Professor of Molecular and Integrative Physiology)

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Baranchuk, A., Morillo, C.A., Thoenes, M., Ventura, R., Connolly, S.J. (2008). Current Role of Medical Therapy for Prevention or Termination of Atrial Fibrillation. In: Natale, A., Jalife, J. (eds) Atrial Fibrillation. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-163-5_13

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  • DOI: https://doi.org/10.1007/978-1-59745-163-5_13

  • Publisher Name: Humana Press

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  • Online ISBN: 978-1-59745-163-5

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