Antiarrhythmic Drug Therapy for Atrial Fibrillation

Antiarrhythmic medications have been available fornearly 100 years and remain a mainstay in the manage-ment of atrial fibrillation (AF). Goals of therapy with the use of these drugs include a reduction in the frequency and duration of episodes of arrhythmia as well an emerging goal of reducing mortality and hospitalizations associated with AF. The use of these drugs has been limited by both proarrhythmic and noncardiovascular toxicities as well as often modest antiarrhythmic efficacy. Despite these limita-tions, antiarrhythmic drugs remain widely prescribed for the management of symptomatic AF, and a host of new antiar-rhythmic drugs are in various stages of clinical development. This review will focus primarily on antiarrhythmic drug use in patients with AF in the absence of significant structural heart disease or congestive heart failure. The Decision to Maintain Sinus Rhyth