Part 2 book “Management of atrial fibrillation” has contents: Use of antiarrhythmic drug treatment in atrial fibrillation, anticoagulation selection and stroke prevention, when to refer patients for non-pharmacological therapies, summary guidelines for the management of atrial fibrillation. | Chapter 5 Use of antiarrhythmic drug treatment in atrial fibrillation Irene Savelieva and A. John Camm Key points • Despite several trials demonstrating non-inferiority of rate control to rhythm control, with some advantages to the former, rhythm control is the preferred treatment strategy in young and active individuals and those who remain symptomatic despite best possible rate control; nevertheless, rate control is relevant to all forms of AF and to all patients with AF. • The choice of an antiarrhythmic drug should be driven by its safety (preferably the effect on hard endpoints such as mortality if available) which, in turn, is determined by the underlying cardiovascular disease and other individual patient characteristics (. co-morbidities and concomitant medication). • Dronedarone can be used safely in patients with non-permanent atrial fibrillation provided they do not have unstable or advanced heart failure; the drug is better avoided or should be used with caution in individuals with milder forms of heart failure unless there is no alternative • Regular electrocardiogram monitoring as well as biochemistry and functional tests (specific for each drug) are mandatory. • In selected patients, short-term use of antiarrhythmic drugs after cardioversion or a ‘pill-in-the-pocket’ strategy can be used in order to minimize the adverse effects. 5. Principles of therapy The main principles of atrial fibrillation (AF) management consist of risk assessment for stroke and appropriate antithrombotic prophylaxis, usually in the form of oral anticoagulation; rhythm control therapy aimed at prevention of recurrent paroxysmal or persistent AF which may include antiarrhythmic drugs, catheter ablation, and cardioversion of arrhythmia which fails to self-terminate; control of ventricular rates during recurrent or permanent AF; and treatment of the conditions that are commonly associated with the occurrence and perpetuation of AF (Camm et al. 20 0). The nature of AF and .
