Table 3.

Mechanism of Action of Recommended Rhythm Control Strategies for Atrial Fibrillation

Rhythm control strategies	Singh and Vaughan-Williams classification	Mechanism of action	Reference(s)
Pharmacological cardioversion
Flecainide	Class Ic	Blocks fast inward sodium channel to reduce rate of  rise of AP depolarization and contractility Selectively effects cells with high rates	(194)
Propafenone	Class Ic	Blocks fast inward sodium current to reduce rate of  rise of AP depolarization and contractility β-adrenergic receptor blocking properties	(69)
Ibutilide	Class IIIc	Blocks the delayed rectifier outward potassium current  and enhances the slow inward sodium current which  both prolong AP duration and conduction	(128, 260)
Dofetilide	Class IIIc	Selectively blocks the delayed rectifier outward  potassium current to prolong AP	(202)
Sotalol	Class IIIc	Blocks the delayed rectifier outward potassium current  to prolong AP β-adrenergic receptor blocking properties	(3)
Amiodarone	Class IIIc	Multi-channel blocker that effects inward sodium and  calcium channels as well as repolarizing outward  potassium channels, which ultimately causes  prolongation of the repolarization phase of the AP  and conduction α- and β-adrenergic receptor and blocking properties	(124)
Electrical cardioversion
Direct current (monophasic  or biphasic waves)	Not applicable	Block reentrant electrical circuits by depolarizing atrial  tissue using high voltage (monphasic waves) or  low-voltage (biphasic) electrical currents to make  atria refractory	(133)
Ablation therapy	Not applicable	Block reentrant electrical circuits by making lesion/scar  lines in and around the pulmonary veins	(256)