Drug Therapy for the Management of Atrial Fibrillation: An Update

Andrew RJ Mitchell

Disclosures

Br J Cardiol. 2003;10(5) 

In This Article

Cardioversion of Persistent Atrial Fibrillation

There are data supporting the use of intravenous flecainide and amiodarone for cardioversion of persistent AF but amiodarone appears to have a delayed time to action.[20,21,22,23] Intravenous propafenone has been shown to convert 91% of patients with persistent AF after 2.5 hours.[24] Intravenous ibutilide is currently the most rapid anti-arrhythmic for chemical cardioversion of AF achieving sinus rhythm in 30–50% of episodes and often within 30 minutes of infusion.[25,26] There is, however, the risk of polymorphic ventricular tachycardia in up to 3% of patients. It is not yet licensed for use in the United Kingdom.

Pharmacological cardioversion can also be achieved with oral anti-arrhythmic drugs, particularly class 1 agents, with a low risk of pro-arrhythmia.[27] The 'pill in the pocket' approach has been shown to be successful with either a single dose of propafenone 600 mg or flecainide 300 mg, restoring 50–80% of episodes to sinus rhythm.[28,29,30]

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