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Antiarrhythmic Drug Therapy in Atrial Fibrillation
Shown below is an algorithm depicting the antiarrhythmic drug therapy for maintain sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation:
| Maintenance of sinus rhythm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No (or minimal) heart disease | Hypertension | Coronary artery disease | Heart failure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dronedarone Flecainide Propafenone Sotalol | Substantial LVH | Dronedarone Dofetilide Sotalol | Amiodarone Dofetilide | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amiodarone Dofetilide | Catheter ablation | No | Yes | Amiodarone | Catheter ablation | Catheter ablation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dronedarone Flecainide Propafenone Sotalol | Amiodarone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Catheter ablation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amiodarone Dofetilide | Catheter ablation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drugs are listed alphabetically and not in order of suggested use.
The seriousness of heart disease progresses from left to right, and selection of therapy in patients with multiple conditions depends on the most serious condition present.
LVH indicates left ventricular hypertrophy.
Algorithm based on the 20011 ACCF/AHA/HRS updates for the management of atrial fibrillation.[1]
- Dabigatran may be used as an alternative to warfarin in those wdo don't have: (I B)
- Prosthetic heart valve
- Hemodynamically significant valve disease
- Severe renal failure (creatinine clearance <15 mL/min) or
- Advanced liver disease (impaired baseline clotting function).
- If patient on anticoagulants with AF sustains stroke or systemic embolism, target INR may be raised to 3.0 - 3.5 (IIb C).
- Anticoagulation therapy can be interrupted for upto 1 week, if patients needs a procedure that carries a risk of bleeding (IIa C). For periods > 1 week unfractionated or low molecular weight heparin may be given IV (IIb C).
- ↑ Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Kay, GN.; Le Huezey, JY. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 123 (10): e269–367. doi:10.1161/CIR.0b013e318214876d. PMID 21382897. Unknown parameter
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