Choice of Prophylactic Medication for Atrial Fibrillation

Choice of prophylactic medication for atrial fibrillation. The choice of prophylactic medication is essentially affected by other (cardiac) diseases of the patient. In outpatient care, the first-line drug is usually a beta blocker. Of the actual antiarrhythmic agents, Class IC drugs (flecainide) are the first-line drugs in lone atrial fibrillation. Quinidine and disopyramide are particularly suitable for the prevention of vagal AF. Structural heart disease is a contraindication for the use of Class I antiarrhythmic agents. The use of sotalol is restricted by the risk of torsades de pointes ventricular tachycardia. Amiodarone and dronedarone cause numerous extra-cardiac adverse effects which restricts their use. ACE inhibitors and angiotensin II receptor blockers (ARBs) appear to prevent the occurrence of AF in patients with heart failure and hypertension.

Drugs in parenthesis may require special permit.

Picture: Finnish Current Care Guidelines