Pharmacological Treatment of Atrial Fibrillation: An Overview

Abstract

Since atrial fibrillation (AF) is the most common arrhythmia that increases with age, AF is becoming a major health issue with an increasing population of elderly people. Non-pharmacological treatment of AF with catheter-based pulmonary vein ablation or isolation has considerably progressed and it may be successfully used in younger and symptomatic patients with refractory paroxysmal AF. In addition, introduction of novel anticoagulants may have a great impact on the treatment of AF. Many large-scale clinical trials comparing rate control with rhythm control have not yet indicated that rhythm control is any better than rate control in decreasing morbidity and mortality rate of AF patients. A possible explanation for the inferiority of rhythm control may be that proarrhythmic risk and toxic effects associated with currently available antiarrhythmic drugs adversely affect outcomes. One of ideal candidates may be an antiarrhythmic drug with selective affinity for the ion channels that are specifically involved in atrial repolarization. Another candidate may be an antiarrhythmic drug with multichannel blocking action, producing successful rhythm control like amiodarone. I will review several novel antiarrhythmic drugs being developed for the treatment of AF. At the present time the rate control strategy will become the first choice for the treatment of AF, especially persistent AF. However, if an effective atrial-selective antiarrhythmic drug without serious side effects is developed, the rhythm control strategy may become another choice for AF therapy.