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Antiarrhythmic drugs to maintain sinus rhythm: recommendations


Before initiating antiarrhythmic drug therapy, treatment of precipitating or reversible causes of atrial fibrillation is recommended. ( Class I; Level of Evidence: C )

The following antiarrhythmic drugs are recommended in patients with atrial fibrillation to maintain sinus rhythm, depending on underlying heart disease and comorbidities ( Class I; Level of Evidence: A ): a. Amiodarone; b. Dofetilide; c. Dronedarone; d. Flecainide; e. Propafenone; f. Sotalol.

The risks of the antiarrhythmic drug, including proarrhythmia, should be considered before initiating therapy with each drug. ( Class I; Level of Evidence: C )

Owing to its potential toxicities, Amiodarone should only be used after consideration of risks and when other agents have failed or are contraindicated. ( Class I; Level of Evidence: C )

A rhythm-control strategy with pharmacological therapy can be useful in patients with atrial fibrillation for the treatment of tachycardia-induced cardiomyopathy. ( Class IIa; Level of Evidence: C )

It may be reasonable to continue current antiarrhythmic drug therapy in the setting of infrequent, well-tolerated recurrences of atrial fibrillation, when the drug has reduced the frequency or symptoms of atrial fibrillation. ( Class IIb; Level of Evidence: C )

Antiarrhythmic drugs for rhythm control should not be continued when atrial fibrillation becomes permanent ( Class III: Harm; Level of Evidence: C ) including Dronedarone. ( Class III: Harm; Level of Evidence: B )

Dronedarone should not be used for treatment of atrial fibrillation in patients with New York Heart Association ( NYHA ) class III and IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 weeks. ( Class III: Harm; Level of Evidence: B ) ( Xagena )

Source: AHA/ACC/HRS Atrial Fibrillation Guideline 2014

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