Table 4.

Drugs for Atrial Fibrillation in patients with Metabolic Syndrome.

Antiarrhythmic Drugs
Amiodarone (Class III—Potassium channel blockers) [93,94]	Preferred in MetS Monitoring of aminotransferases Dosage modification in obesity
Dronedarone (Class III—Potassium channel blockers) [95]	Less hepatotoxic Less studied drug Effective in diabetics
Class I—Sodium channel blockers [96]	Reduce expression of sodium channels in obesity Reduce efficacy in obesity
Class II—B blockers [97,98,99,100,101,102,103,104]	Cardioelective b-blockers: weight gain, glucose intolerance, induce new-onset diabetes -> not suggested B-blockers with a-adrenergic effect (carvedilol): improve metabolic parameters -> suggested Vasodilating b-blockers (Nebivolol): improve metabolic parameters-> suggested
Class IV—Nondihydropyridine Calcium channel blockers	Data exist only for Dihydropyridine calcium channel blockers that lack antiarrhythmic effect
Anticoagulants
Dabigatran [105,106,107,108]	Low dose (110 mg BID) best for diabetics Higher risk of bleeding in obesity
Rivaroxaban [105,106,107,108,109,110]	Second best option for diabetics/full dose (20 mg daily) Safer profile than Apixaban Safe for extremely overweight
Apixaban [110,111,112,114,115]	Safe in obesity Safe for extremely overweight Best option for obese patients with heart failure and AF
Edoxaban [113]	Last option, due to high bleeding risk