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Table 12. Antiarrhythmic Drugs to Maintain Sinus Rhythm
Recommendations COR LOE
Before initiating antiarrhythmic drug therapy, treatment of
precipitating or reversible causes of AF is recommended.
I C
e following antiarrhythmic drugs are recommended in
patients with AF to maintain sinus rhythm, depending on
underlying heart disease and comorbidities:
a. Amiodarone
b. Dofetilide
c. Dronedarone
d. Flecainide
e. Propafenone
f. Sotalol
I A
e risks of the antiarrhythmic drug, including
proarrhythmia, should be considered before initiating therapy
with each drug.
I C
Because of its potential toxicities, amiodarone should only be
used aer consideration of risks and when other agents have
failed or are contraindicated.
I C
A rhythm-control strateg y with pharmacological therapy can
be useful in patients with AF for the treatment of tachycardia-
induced cardiomyopathy.
IIa C
It may be reasonable to continue current antiarrhythmic drug
therapy in the setting of infrequent, well-tolerated recurrences of
AF when the drug has reduced the frequency or symptoms of AF.
IIb C
Antiarrhythmic drugs for rhythm control should NOT be
cont'd when AF becomes permanent,
III: Harm C
• including dronedarone.
III: Harm B
Dronedarone should NOT be used for treatment of AF in
patients with NYHA class III and IV HF or patients who
have had an episode of decompensated HF in the past
4 weeks.
III: Harm B
Table 13. Upstream Therapy
Recommendations COR LOE
An ACE inhibitor or ARB is reasonable for primary
prevention of new-onset AF in patients with HF with
reduced LVEF.
IIa B
erapy with an ACE inhibitor or ARB may be considered
for primary prevention of new-onset AF in the setting of
hypertension.
IIb B
Statin therapy may be reasonable for primary prevention of
new-onset AF aer coronary artery surgery.
IIb A
erapy with an ACE inhibitor, ARB, or statin is NOT
beneficial for primary prevention of AF in patients without
cardiovascular disease.
III: No
Benefit
B
