91
8.3.1. Specific Drug Therapy for Long-Term Maintenance of
Sinus Rhythm
COR LOE
Recommendations
2a A* 1. For patients with AF and HFrEF (≤40%), therapy with
dofetilide* or amiodarone
†
is reasonable for long-term
maintenance of sinus rhythm. B-NR
†
2a A 2. For patients with AF and no prior MI, or known or suspected
significant structural heart disease, or ventricular scar or
fibrosis, use of flecainide or propafenone is reasonable for
long-term maintenance of sinus rhythm.
2a A 3. For patients with AF without recent decompensated HF or
severe LV dysfunction, use of dronedarone is reasonable for
long-term maintenance of sinus rhythm.
2a A 4. For patients with AF without significant baseline QT interval
prolongation, uncorrected hypokalemia or hypomagnesemia,
use of dofetilide is reasonable for long-term maintenance of
sinus rhythm, with proper dose selection based on kidney
function and close monitoring of the QT interval, serum
potassium and magnesium concentrations, and kidney function.
2a A 5. For patients with AF and normal LV function, use of low-dose
amiodarone (100–200 mg/d) is reasonable for long-term
maintenance of sinus rhythm, but in view of its adverse effect
profile should be reserved for patients in whom other rhythm
control strategies are ineffective, not preferred, or contraindicated.
2b A 6. For patients with AF without significant baseline QT interval
prolongation, hypokalemia, hypomagnesemia, or bradycardia, use
of sotalol may be considered for long-term maintenance of sinus
rhythm, with proper dose selection based on kidney function and
close monitoring of the QT interval, heart rate, serum potassium
and magnesium concentrations, and kidney function.
3: Harm B-R 7. In patients with prior MI and/or significant structural heart
disease, including HFrEF (LVEF ≤40%), flecainide and
propafenone should not be administered to due to the risk of
worsening HF, potential proarrhythmia, and increased mortality.
3: Harm B-R 8. For patients with AF, dronedarone should not be
administered for maintenance of sinus rhythm to those with
New York Heart Association (NYHA) class III and IV HF
or patients who have had an episode of decompensated HF in
the past 4 weeks, due to the risk of increased early mortality
associated with worsening HF.
* A LOE applies to data on dofetilide.
†
B-NR LOE applies to data on amiodarone.
8.3. AADs for Maintenance of Sinus Rhythm
