Atrial fibrillation maintenance of sinus rhythm


 * Associate Editor(s)-In-Chief: ; Varun Kumar, M.B.B.S.

Overview
Prophylactic antiarrhythmic drug therapy may be required to maintain sinus rhythm, reduce frequency of symptoms, improve hemodynamic function and exercise capacity and prevent tachycardia-induced cardiomyopathy secondary to atrial fibrillation. In patients with heart failure, pharmacological maintenance of sinus rhythm has shown to reduce morbidity.

==ACCF/AHA/HRS 2011 Guidelines- Maintenance of Sinus Rhythm (DO NOT EDIT) == {{cquote|

Class I
1. Before initiating antiarrhythmic drug therapy, treatment of precipitating or reversible causes of AF is recommended. (Level of Evidence: C)

Class IIa
1. Pharmacological therapy can be useful in patients with AF to maintain sinus rhythm and prevent tachycardia-induced cardiomyopathy. (Level of Evidence: C)

2. Infrequent, well-tolerated recurrence of AF is reasonable as a successful outcome of antiarrhythmic drug therapy. (Level of Evidence: C)

3. Outpatient initiation of antiarrhythmic drug therapy is reasonable in patients with AF who have no associated heart disease when the agent is well tolerated. (Level of Evidence: C)

4. In patients with lone AF without structural heart disease, initiation of propafenone or flecainide can be beneficial on an outpatient basis in patients with paroxysmal AF who are in sinus rhythm at the time of drug initiation. (Level of Evidence: B)

5. Sotalol can be beneficial in outpatients in sinus rhythm with little or no heart disease, prone to paroxysmal AF, if the baseline uncorrected QT interval is less than 460 ms, serum electrolytes are normal, and risk factors associated with class III drug–related pro-arrhythmia are not present. (Level of Evidence: C)

6. Catheter ablation is a reasonable alternative to pharmacological therapy to prevent recurrent AF in symptomatic patients with little or no LA enlargement. (Level of Evidence: C)

Class III
1. Antiarrhythmic therapy with a particular drug is not recommended for maintenance of sinus rhythm in patients with AF who have well-defined risk factors for proarrhythmia with that agent. (Level of Evidence: A)

2. Pharmacological therapy is not recommended for maintenance of sinus rhythm in patients with advanced sinus node disease or AV node dysfunction unless they have a functioning electronic cardiac pacemaker. (Level of Evidence: C)}}

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Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter