Antiarrhythmic Drugs for Managing AFib: A Meta-Analysis

Modest efficacy in preventing recurrence of atrial fibrillation must be weighed against adverse drug effects.

Antiarrhythmic drugs (AADs) are generally considered first-line therapy for symptomatic atrial fibrillation (AF). These researchers conducted a meta-analysis of 44 randomized controlled trials (involving 11,322 patients; mean age, about 60) of AAD therapy for maintaining sinus rhythm after cardioversion of AF. All trials lasted at least 6 months. Persistent AF was the most common AF type (60% of subjects), and most patients had normal LV function.

AF recurrence rates were significantly lower among recipients of any AAD in classes IA, IC, and III (except dronaderone) than among controls (ranges, 44%–67% vs. 71%–84%). Amiodarone (a class III drug) was significantly better at preventing AF recurrence than were class IA drugs as a pooled group. …

Reviewing Author

Hugh Calkins, MD