pharmaceutical agents for treatment of atrial fibrillation

Management

• rate control
  • lone atrial fibrillation
    • calcium channel blocker (agents of choice)
    • beta-blocker
  • hypertension
    • beta blocker (agents of choice)
    • calcium channel blocker
  • coronary artery disease
    • beta blocker (agents of choice)
    • digoxin
  • congestive heart failure
    • beta blocker (agents of choice)
    • digoxin
    • consider AV nodal ablation
  • vagal
    • calcium channel blocker (agents of choice)
    • beta-blocker
    • avoid digoxin
  • Wolf-Parkinson-White syndrome with rapid ventricular response
    • AV nodal agents contraindicated
• antiarrhythmic therapy
  • lone atrial fibrillation
    • flecainide* or propafenone* (agents of choice)
    • sotalol or dofetilide*
  • hypertension
    • sotalol or propafenone* (agents of choice)
    • dolfetilide* or amiodarone
  • coronary artery disease
    • sotalol (agent of choice)
    • amiodarone or dolfetilide*
  • congestive heart failure
    • amiodarone (agent of choice)
    • dolfetilide*
  • vagal
    • disopyramide* (agent of choice)
    • propafenone*
  • Wolf-Parkinson-White syndrome with rapid ventricular response
    • cardioversion if unstable
    • procainamide IV
• anticoagulation (see atrial fibrillation)

* requires concurrent rate-controlling agent (beta-blocker)