Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials

摘要: In managing atrial fibrillation (AF), the main therapeutic strategies include rate control, termination of arrhythmia, and prevention recurrences thromboembolic events. Safety efficacy considerations are important in optimizing choice an antiarrhythmic drug for treatment AF. Recently approved antiarrhythmics, such as dofetilide, promising investigational drugs, azimilide dronedarone, may change landscape For medical conversion recent-onset AF, class IC administered oral bolus, have been demonstrated to be most efficacious pharmacologic agents. Intravenous ibutilide dofetilide both efficacies superior placebo controlled trials converting persistent Comparative paroxysmal AF that flecainide, propafenone, quinidine, sotalol equally effective preventing Amiodarone has more than propafenone or Canadian Trial Atrial Fibrillation. twice-daily shown low-dose given twice daily maintenance sinus rhythm patients with Trials subjective adverse effects less frequent sotalol, compared drugs quinidine. without structural heart disease, D,L-sotalol initial choice, their reasonable efficacy, low incidence side effects, lack significant end-organ toxicity. Treating left ventricular dysfunction can difficult because associated electrophysiologic derangements, potential proarrhythmic concerns, negative inotropic antiarrhythmics. Some data exist suggesting angiotensin-converting enzyme inhibitors angiotensin receptor blockers prevent either by dilation stretch-induced arrhythmias blocking renin-angiotensin system. post-myocardial infarction patients, D,L-sotalol, amiodarone-and congestive failure amiodarone dofetilide-have neutral on survival trials. Congestive Heart Failure Survival Antiarrhythmic Therapy (CHF-STAT), lowered frequency development improved ejection fraction over time. CHF-STAT, there was lower mortality who converted from rhythm. Dofetilide decreased rehospitalization Danish Investigations Arrhythmia Mortality (DIAMOND) Neutral favorable hemodynamics positioned antiarrhythmics dysfunction. is additional agent consider this setting.