What are the guidelines for maintaining sinus rhythm in patients with atrial fibrillation (Afib) (AF)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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The 2014 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) guidelines include the following recommendations for the prevention of atrial fibrillation (AF) and maintenance of sinus rhythm [1] :

  • Precipitating or reversible causes of AF should be treated before initiation of antiarrhythmic drug therapy; antiarrhythmic drug therapy can be considered for treatment of tachycardia-induced cardiomyopathy

  • Antiarrhythmic drugs include amiodarone, dofetilide, dronedarone, flecainide, propafenone, and sotalol; drug selection should be based on underlying heart disease and comorbidities

  • Consider risks, including proarrhythmia, before initiating antiarrhythmic drug treatment

  • Amiodarone should be used only after consideration of its potential toxicities and risks, and when other agents have failed or are contraindicated

  • Discontinue antiarrhythmic drugs, including dronedarone, when AF becomes permanent

  • Dronedarone is contraindicated for treatment of AF in patients with New York Heart Association (NYHA) class III and IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 weeks

The European Society of Cardiology (ESC) recommendations for maintenance of sinus rhythm are similar to those in the AHA/ACC/HRS. [149]

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