Drug therapy for termination of atrial fibrillation and maintenance of sinus rhythm.

Antiarrhythmic drug therapy to maintain sinus rhythm has not been demonstrated in randomized clinical trials to improve prognosis or prevent thromboembolic complications in patients with atrial fibrillation (AF). Therefore, drug therapy to restore and maintain sinus rhythm should be limited to those patients who have a greater symptomatic burden of AF. Patients with AF may be completely unaware of their arrhythmia or may present with palpitations, poor exercise tolerance or symptoms of congestive heart failure. In general, younger patients with paroxysmal arrhythmia and patients with decreased left ventricular compliance tend to be more symptomatic. The present article outlines the mechanisms of action of antiarrhythmic drugs in AF. Drugs that are recommended and frequently used to convert AF and maintain sinus rhythm are reviewed, and the toxicity of antiarrhythmic drug toxicity is discussed.