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Review
. 2006 Mar;29(3):97-102.
doi: 10.1002/clc.4960290303.

Antiarrhythmic drug therapy for atrial fibrillation: are the guidelines guiding clinical practice?

James A Reiffel  1 , Gerald V Naccarelli
Affiliations
Review

Antiarrhythmic drug therapy for atrial fibrillation: are the guidelines guiding clinical practice?

James A Reiffel et al. Clin Cardiol. 2006 Mar.

Abstract

The AFFIRM study showed no clear survival advantage for a rhythm versus rate control strategy in patients with atrial fibrillation (AF). However, rhythm control with antiarrhythmic drugs (AADs) is appropriate in a large number of patients with AF. The American College of Cardiology/ American Heart Association/European Society of Cardiology AF management guidelines include a safety-based algorithm for selection of AAD therapy. Class 1C agents are recommended as first-line therapy in patients without or with minimal structural heart disease. However, market research and clinical study data indicate a growing use of class III agents (mainly amiodarone) despite long-term safety and tolerability concerns, suggesting that clinical practice does not adhere to current guidelines.

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