Recommendations for Specific Drug Therapy for Long-Term Maintenance of Sinus Rhythm
Referenced studies that support the recommendations are summarized in the Online Data Supplement.
| COR | LOE | Recommendations |
|---|---|---|
| 2a | A * | 1. For patients with AF and HFrEF (≤40%), therapy with dofetilide*1 or amiodaronet2 is reasonable for long-term maintenance of sinus rhythm. |
| B-NR † | ||
| 2a | A | 2. For patients with AF and no previous MI, or known or suspected significant structural heart disease, or ventricular scar or fibrosis, use of tlecainide3–5 or propafenone5–12 is reasonable for long-term maintenance of sinus rhythm. |
| 2a | A | 3. For patients with AF without recent decompensated HF or severe LV dysfunction, use of dronedarone5,13–15 is reasonable for long-term maintenance of sinus rhythm. |
| 2a | A | 4. For patients with AF without significant baseline QT interval prolongation or uncorrected hypokalemia or hypomagnesemia, use of dofetilide1,5,16 5–7,10,17,18 is reasonable for long-term maintenance of sinus rhythm, with proper dose selection based on kidney function and close monitoring of the QT interval, serum potassium and magnesium concentrations, and kidney function. |
| 2a | A | 5. For patients with AF and normal LV function, use of low-dose amiodarone (100–200 mg/d) is reasonable for long-term maintenance of sinus rhy thm2,5,17–22 but, in view of its adverse effect profile,5,23,24 should be reserved for patients in whom other rhythm control strategies are ineffective, not preferred, or contraindicated. |
| 2b | A | 6. For patients with AF without significant baseline QT interval prolongation, hypokalemia, hypomagnesemia, or bradycardia, use of sotalol5–7,10,17,18 may be considered for long-term maintenance of sinus rhythm, with proper dose selection based on kidney function and close monitoring of the QT interval, heart rate, serum potassium and magnesium concentrations, and kidney function. |
| 3: Harm | B-R | 7. In patients with previous MI and/or significant structural heart disease, including HFrEF (LVEF ≤40%), flecainide and propafenone25 should not be administered due to the risk of worsening HF, potential proarrhythmia, and increased mortality.26,27 |
| 3: Harm | B-R | 8. For patients with AF, dronedarone should not be administered for maintenance of sinus rhythm to those with NYHA class III and IV HF or patients who have had an episode of decompensated HF in the past 4 weeks, due to the risk of increased early mortality associated with worsening HF.28 |
*
A LOE applies to data on dofetilide.
†
B-NR LOE applies to data on amiodarone.