Current trends in antiarrhythmic drug therapy of atrial fibrillation

Despite the increasing number and promising results of catheter ablations and cardiac surgeries to manage atrial fibrillation (AF),

drug therapy currently remains the mainstay of treatment in various forms of AF. Two major strategies of this treatment are distinguished:

heart rate control and heart rhythm control. To restore and maintain the sinus rhythm, three antiarrhythmic drugs – propafenone,

sotalol, and flecainide – are mainly used in patients without structural cardiac disease; in those with cardiac damage, amiodarone is

preferred. New antiarrhythmic drugs are being developed such as selective ones for atrial myocardium, or amiodarone analogues with

a substantially lower risk of adverse effects (e. g. dronedarone). Attention is also paid to medications suppressing the development of

arrhythmogenic substrate in the atria (ACE inhibitors, sartans, statins etc.). The medications mentioned above are also administered to

enhance the effect of nonpharmacological treatment within the so-called hybrid therapy.

Keywords: antiarrhythmic medications, atrial fibrillation, antiremodelling therapy