Atrial Fibrillation: Antiarrhythmic Therapy

Atrial fibrillation is the most common cardiac arrhythmia and is associated with significant morbidity, mortality, and economic cost. Although the benefit of anticoagulation has been well described, control of the underlying rhythm disturbance can be achieved in various ways. Numerous therapeutic options exist and continue to be developed; however, the single best strategy has not been elucidated, and rate or rhythm controlling strategies may both be undertaken. The selection of particular agents to successfully achieve these strategies takes into account patient preference and comorbidity, as well as the efficacy and side effect profiles of the possible medications. This review discusses the evidence behind the various agents typically used to treat atrial fibrillation as well as provides a framework on which to make clinical decisions while initiating and continuing therapy.