How to Choose an AAD for Managing AF?
AADs Available for Rhythm Control
Antiarrhythmic drugs act to suppress the firing of or depress the transmission of abnormal electrical signals.
Choice of AAD is primarily guided by safety considerations, including: 1
- ABSOLUTE or RELATIVE CONTRAINDICATIONS
- RISK FACTORS for adverse events such as onset of new arrhythmia or exacerbation of existing arrhythmia and effects outside the heart
- FACTORS that influence DRUG DISPOSITION such as patient age and renal or hepatic function
- PATIENT PREFERENCE
As patients are ultimately responsible for taking their medication, placing patients in a central role in the decision-making process is recommended to improve patient compliance and reduce the risk of the clinical consequences of AF. 1
What Is the Clinical Impact of AAD Therapy?
Antiarrhythmic drug therapy is fairly safe and moderately effective at maintaining normal sinus rhythm; its impact on consequences such as stroke, heart failure and mortality have been demonstrated in a limited number of studies.
The toxicity profile of AADs is varied, frequently including drug-induced arrhythmia in 2%-4% of patients, and adverse events leading to treatment discontinuation in 12%-19% of patients: 1,2,5
1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37 (38): 2893-2962.
2. Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J (2015) Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev (3): Cd005049.
3. Jais P, Cauchemez B, Macle L, Daoud E, Khairy P et al. (2008) Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 118 (24): 2498-2505.
4. Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y et al. (2009) Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2 (4): 349-361.
5. Camm J (2012) Antiarrhythmic drugs for the maintenance of sinus rhythm: risks and benefits. Int J Cardiol 155 (3): 362-371.
6. Weerasooriya R, Jais P, Le Heuzey JY, Scavee C, Choi KJ et al. (2003) Cost analysis of catheter ablation for paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 26 (1 Pt 2): 292-294.
126680-191029 EMEA; 123104-200130 EMEA; 125888-191019 EMEA