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Use of antiarrhythmic drug treatment in atrial fibrillation 

Use of antiarrhythmic drug treatment in atrial fibrillation
Use of antiarrhythmic drug treatment in atrial fibrillation
Management of Atrial Fibrillation (Oxford Cardiology Library): A Practical Approach

Irene Savelieva

and A. John Camm


The management of recurrent episodes of atrial fibrillation (AF) is conventionally based on rate control with resort to rhythm control only if significant symptoms persist. More recently the realization that rhythm control may impede the progression of recurrent AF to permanent AF and that left atrial ablation is successful in maintaining sinus rhythm have swung clinical opinion in favour of rhythm control, in addition to background rate control. Rhythm control can be achieved by the use of antiarrhythmic drugs, upstream therapy, left atrial ablation, or a hybrid of these techniques. Antiarrhythmic agents are limited to blockers of the beta sympathetic receptors, sodium channels (flecainide and propafenone), potassium channels (dofetilide and sotalol), and multiple ion channels (amiodarone and dronedarone). The choice between antiarrhythmic agents is based predominantly on safety consideration rather than efficacy. There remains an important role for antiarrhythmic drug therapy prior to, or in conjunction with, left atrial ablation, for the prevention of AF recurrence and the progression to permanent AF.

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