pharmaceutical agents for treatment of atrial fibrillation

Management: 1) rate control a) lone atrial fibrillation - calcium channel blocker (agents of choice) - beta-blocker b) hypertension - beta blocker (agents of choice) - calcium channel blocker c) coronary artery disease - beta blocker (agents of choice) - digoxin d) congestive heart failure - beta blocker (agents of choice) - digoxin - consider AV nodal ablation e) vagal - calcium channel blocker (agents of choice) - beta-blocker - avoid digoxin f) Wolf-Parkinson-White syndrome with rapid ventricular response - AV nodal agents contraindicated 2) antiarrhythmic therapy a) lone atrial fibrillation - flecainide* or propafenone* (agents of choice) - sotalol or dofetilide* b) hypertension - sotalol or propafenone* (agents of choice) - dolfetilide* or amiodarone c) coronary artery disease - sotalol (agent of choice) - amiodarone or dolfetilide* d) congestive heart failure - amiodarone (agent of choice) - dolfetilide* e) vagal - disopyramide* (agent of choice) - propafenone* f) Wolf-Parkinson-White syndrome with rapid ventricular response - cardioversion if unstable - procainamide IV 3) anticoagulation (see atrial fibrillation) * requires concurrent rate-controlling agent (beta-blocker)

References

Feliciano, Z. In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001