Treatment
22
Table 14. Dosage and Safety Considerations for Maintenance
of Sinus Rhythm in AF (cont'd)
Drug Usual Doses
Exclude/Use With
Caution
Major Pharmacokinetic
Drug Interactions
Vaughan Williams Class III (cont'd)
Sotalol 40-160 mg once
every 12 h
• Prolonged QT interval
• Renal disease
• Hypokalemia
• Hypomagnesemia
• Diuretic therapy
• Avoid other QT interval-
prolonging drugs
• Sinus or AV nodal
dysfunction
• HF
• Asthma
None (renal excretion)
Table 15. AF Catheter Ablation to Maintain Sinus Rhythm
Recommendations COR LOE
AF catheter ablation is useful for symptomatic paroxysmal AF
refractory or intolerant to at least 1 class I or III antiarrhythmic
medication when a rhythm-control strategy is desired.
I A
Before consideration of AF catheter ablation, assessment of
the procedural risks and outcomes relevant to the individual
patient is recommended.
I C
AF catheter ablation is reasonable for some patients with
symptomatic persistent AF refractory or intolerant to at least
1 class I or III antiarrhythmic medication.
IIa A
In patients with recurrent symptomatic paroxysmal AF,
catheter ablation is a reasonable initial rhythm-control
strateg y before therapeutic trials of antiarrhythmic drug
therapy, aer weighing the risks and outcomes of drug and
ablation therapy.
IIa B
AF catheter ablation may be considered for symptomatic
long-standing (>12 months) persistent AF refractory or
intolerant to at least 1 class I or III antiarrhythmic medication
when a rhythm-control strateg y is desired.
IIb B
AF catheter ablation may be considered before initiation
of antiarrhythmic drug therapy with a class I or III
antiarrhythmic medication for symptomatic persistent AF
when a rhythm-control strateg y is desired.
IIb C
AF catheter ablation should NOT be performed in patients
who cannot be treated with anticoagulant therapy during and
following the procedure.
III: Harm C
AF catheter ablation to restore sinus rhythm should NOT
be performed with the sole intent of obviating the need for
anticoagulation.
III: Harm C
