Antiarrhythmic drug therapy: what is certain and what is to come
Cardiology Division, General Hospital, Piacenza, Italy
* Alessandro Capucci, MD, FESC, FACC, Cardiology Division, General Hospital, Via Taverna, 49-29100 Piacenza, Italy
Abstract
Despite recent advances in our understanding of the mechanisms and consequences of atrial fibrillation (AF), effective therapy for patients with AF remains difficult in many patients. Antiarrhythmic drug therapy includes control of ventricular rate as well as restoration and maintenance of sinus rhythm. The risks and benefits of each treatment modality must be assessed according to each patient's circumstances. What is certain is that pharmacological treatment remains the mainstay of AF therapy. However, unlike other arrhythmias, there is still no highly effective therapy for treating AF. Class IC drugs, administered orally or intravenously, remain the first-choice therapy in patients with no organic heart disease. Ibutilide has recently been released for intravenous administration and results in a higher conversion rate, especially in patients with atrial flutter. A recently reported trial showed superiority of amiodarone over conventional antiarrhythmic drugs in maintaining sinus rhythm. Dofetilide is another new compound that was developed mainly for maintenance of sinus rhythm. Control of ventricular rate alone is a common strategy and is considered by many physicians to be the safest treatment option; also, it is a relatively simple approach, particularly in the elderly. Calcium channel blockers, beta-blockers and digitalis remain the more effective drugs in controlling heart rate. What is to come is a number of new antiarrhythmic drugs, mainly class III substances, with promising safety and effectiveness profiles, but they are still far from the marketing process. Recently reported studies showed how the rate control option could be a primary strategy in selected patients.
Key Words: Antiarrythmic therapy • Atrial fibrillation