Antiarrhythmic therapy in patients with atrial fibrillation

Czech version

Authors: R. Čihák
Authors‘ workplace: Klinika kardiologie, Oddělení arytmologie, IKEM, Praha
Published in: Kardiol Rev Int Med 2017, 19(4): 226-230

Overview

The aim of antiarrhythmic therapy in patients with atrial fibrillation is mainly to improve symptoms by heart rate and rhythm control. Rate control is often sufficient. Compared to the robust data on stroke prevention, there is very little evidence to inform the best type and intensity of rate control treatment. Both acute and long-term pharmacological rate control can be achieved with beta-blockers, digoxin, calcium channel blockers (diltiazem and verapamil), or combination therapy. Restoring and maintaining sinus rhythm is also an integral part of AF management. Propafenone, flecainide, sotalol, dronedarone and amiodarone can be used. Antiarrhythmic drugs approximately double the probability of sustained sinus rhythm compared with placebo. Catheter ablation or combination therapy is often effective when antiarrhythmic drugs fail. Although it was expected that maintaining sinus rhythm can improve the outcomes in AF patients, trials comparing rhythm control and rate control showed no difference.

Key words:
atrial fibrillation – antiarrhythmic drugs – rate control – rhythm control

Sources

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