Abstrait

New antiarrhythmic agents for atrial fibrillation

Anirban Choudhury and Gregory YH Lip

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, with an incidence that increases twofold every decade after 55 years of age. Despite recent advances in our understanding of the mechanisms of AF, effective treatment remains difficult in many patients. Pharmacotherapy remains the mainstay of treatment and includes ventricular rate control as well as restoration and maintenance of sinus rhythm. In the light of studies demonstrating safety concerns with class IC agents, class III agents such as sotalol and amiodarone have become the preferred and most commonly used drugs. Unfortunately, a plethora of side effects often limits the long-term use of amiodarone. Thus, there have been many recent developments in antiarrhythmic drug therapy for AF that have gained more interest, particularly with the recent debate over rate versus rhythm control. It is hoped that the availability of the newer agents will at least provide a greater choice of therapies and improve our management of this common arrhythmia.