Benefits and risks of antiarrhythmic drug therapy after DC electrical cardioversion of atrial fibrillation or flutter.

Electrical cardioversion is the method of choice to restore sinus rhythm in patients with chronic atrial fibrillation. After cardioversion, long-term maintenance of sinus rhythm is troublesome since many patients relapse. In addition, haemodynamic complications associated with recurrence and hazards of prophylactic antiarrhythmic drug therapy are among the problems threatening these patients. Several new antiarrhythmics have become available but their safety remains to be established. Advantages of prophylactic antiarrhythmic treatment must be carefully weighed against the hazards. As a consequence, non-pharmacological modalities like serial electrical cardioversions (no drugs) and His bundle ablation may become important treatment modalities. The present report summarizes current antiarrhythmic strategies, focusing primarily on feasibility of prophylactic treatment and on early and late proarrhythmia.