Management of atrial fibrillation, what to know on old and new antiarrhythmics

The management of atrial fibrillation, despite the development of ablative techniques, is mainly a pharmacological issue. For the last 25 years, no new oral antiarrhythmic drug has been launched in France. Class I antiarrhythmic drugs are efficient and safe if they are prescribed taking into account their contra-indications, but their therapeutic index is narrow. Class III antiarrhythmic drugs have limits, mainly due to the repolarization prolongation they induce and the risk of torsades de pointes. The mode of action of new antiarrhythmic drugs are based on an IKur blocking approach or on a multichannel blockade approach like that of dronedarone which is the only antiarrhythmic drug, to date, to have demonstrated an interest in terms of morbi-mortality in atrial fibrillation. (C) 2010 Elsevier Masson SAS. All rights reserved.