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Table 8. Antiarrhythmic Drug Therapy Options for Patients
With HCM and AF
Antiarrhythmic
Drug
Efficacy
for AF Adverse Effects Toxicities Use in HCM
Disopyramide Modest • Anticholinergic
• HF
• Prolonged
QTc
• TdP
• Particularly
with early
onset AF
• Generally used
in conjunction
with
atrioventricular
nodal blocking
agents
Flecainide and
propafenone
… Prolonged QRS • Proarrhythmia
• Typical atrial
flutter
Not generally
recommended in
the absence of an
ICD
Sotalol Modest • Fatigue
• Bradycardia
• Prolonged
QTc
• TdP
Reasonable
Dofetilide Modest Headache • Prolonged
QTc
• TdP
Reasonable
Dronedarone Low HF Prolonged QTc
...
Amiodarone Modest-
high
Bradycardia • Liver, lung,
thyroid, skin,
neurologic
• Prolonged
QTc
Reasonable
AF indicates atrial fibrillation; HCM, hypertrophic cardiomyopathy; HF, heart failure; ICD,
implantable cardioverter-defibrillator; and TdP, torsades de pointes.
