Antiarrhythmic Therapy for Atrial Fibrillation

Laura V. Tsu, PharmD, BCPS


US Pharmacist. 2013;38(2):20-23. 

In This Article

Abstract and Introduction


Antiarrhythmic therapy for atrial fibrillation comprises a broad range of medications that are used to prevent conversion from normal sinus rhythm to atrial fibrillation, as well as to control symptoms. These medications, although effective, require extensive monitoring and patient education. The antiarrhythmics most commonly used to maintain normal sinus rhythm in atrial fibrillation patients are the class IC agents flecainide and propafenone and the class III agents amiodarone, dronedarone, sotalol, and dofetilide. Recommended monitoring parameters include renal and hepatic function, drug interactions, QT prolongation, and exacerbation of heart failure. Patient education should include drug interactions, adverse effects, and recommendations for laboratory monitoring. Community pharmacists are in a unique position to provide guidance on these medications to patients and providers.


A trial fibrillation affects more than 2 million people in the United States, making it the most common atrial arrhythmia.[1] It also accounts for one-third of hospitalizations for cardiac arrhythmias. This high prevalence is likely due to a combination of factors, including the increased incidence of chronic heart disease and the aging of the population. The median age of patients with atrial fibrillation is 75 years, with 70% of patients aged between 65 and 85 years.[1] Common heart conditions that can lead to or exacerbate atrial fibrillation include heart failure (HF), coronary artery disease (CAD), cardiac surgery, and valvular disease.

Atrial fibrillation is caused by ectopic foci that arise in the atria, commonly after structural heart damage. These foci cause the atria to beat irregularly and out of coordination with the ventricles. Chronic atrial fibrillation can adversely affect a patient's quality of life; most patients experience some degree of palpitation, dizziness, and dyspnea. More severe symptoms can occur when abnormal signals transmit to the ventricles, causing a rapid ventricular response that can result in hypotension, tachycardia, syncope, and chest pain. Another serious complication of atrial fibrillation is the higher risk of stroke or transient ischemic attack (TIA) due to a cardioembolic thrombus.