Current strategies of antiarrhythmic drug therapy for paroxysmal atrial fibrillation

Atrial fibrillation is now recognized as a significant medical and social problem. Atrial fibrillation not only causes cardiovascular complications, including thromboembolism and heart failure, but also decreases the survival of patients with impaired left ventricular function; thus, it is considered an independent factor for cardiovascular death. The goal of antiarrhythmic drug therapy for atrial fibrillation is improvement of daily quality of life and cardiovascular prognosis in maintaining sinus rhythm, while ensuring the safety of antiarrhythmic drugs. Antiarrhythmic drugs are prescribed to prevent recurrence of atrial fibrillation; however, they demonstrate limited efficacy. Recently, catheter ablation has been established as a promising new therapy to prevent recurrence of atrial fibrillation, even though this procedure would be difficult to apply clinically because of its complications and the large number of patients requiring treatment. Since the antiarrhythmic drugs remain the first-line, primary therapy for paroxysmal atrial fibrillation, clinicians should select appropriate antiarrhythmic drugs for treatment of paroxysmal atrial fibrillation based on individual patient characteristics. Herein, I review the current strategies of antiarrhythmic drug therapy for paroxysmal atrial fibrillation from the point of view of pharmacological prevention of atrial fibrillation recurrence, improvement of patient quality of life, and cardiovascular prognosis. (C) 2012 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.