ABSTRACT
There are several therapeutic applications for antiarrhythmic drugs (AADs) in patients with atrial fibrillation (AF). AAD may be used (1) to produce cardioversion, (2) to facilitate direct current (DC) cardioversion by reducing defibrillation thresholds (class III AADs), (3) to prevent immediate or early reversion (IRAF and ERAF, respectively) after cardioversion during postconversion remodeling (short-term therapy), (4) to maintain normal sinus rhythm (NSR) during chronic therapy, and (5) to facilitate conversion of fibrillation to flutter (class IA and IC AADs and amiodarone), which may then be amenable to termination or preventionwith antitachycardia pacing or ablative techniques. The major focus of this chapter is the use of AADs to maintain NSR over the long term in patients with paroxysmal AF (PAF) or after conversion in patients with persistent AF. It should be noted, however, that the algorithmic approach to selecting AAD for short-term therapy (weeks to 1 to 3 months) should be the same as that detailed herein for long-term (chronic) therapy.
