The role of antiarrhythmic drugs in atrial fibrillation

Atrial fibrillation(AF) is the most common sustained cardiac arrhythmia, and is associated with a significantly increased risk of thromboembolic events and mortality. From the age of 50 years, prevalence of AF doubles every 10 years, being more common in males and reaching 5.9% in patients 65 years and older. The treatment of AF has as first objective the restoration and maintenance of sinus rhythm. The drugs used to date present several limitations in terms of side and pro-arrhythmic effects, associated with a limited antiarrhythmic effect. Recent European guidelines for the management of AF have pointed out that the pharmacological antiarrhythmic therapy to maintain sinus rhythm is helpful for symptoms related to the arrhythmia. Amiodarone is the drug with the greatest potential for maintenance of sinus rhythm in the older population as well. Other drugs currently in use are flecainide, propafenone, sotalol, and more recently introduced dronedarone and vernakalant. To date, there is no consensus among scientific societies on the management of AF: for elderly patients, who account for the majority of patients with AF, a strictly individualized evaluation is mandatory. © 2013 Il Pensiero Scientifico Editore.