Table 46.

Recommendation and Levels of Evidence for Pharmacological AF Defibrillation

	COR	LOE	GOR (MINDS)	LOE (MINDS)
Use of Na⁺ channel blocker*¹ for AF lasting <48 h without any significant organic heart disease ² , ¹¹⁰ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴ , ⁵⁴⁵	I	A	A	I
Use of Na⁺ channel blocker¹ for AF lasting for 48 h to 7 days with appropriate antithrombotic strategy² ² , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁵ , ⁵³⁶	IIa	C	C1	IVb
Use of bepridil for AF lasting >7 days with normal cardiac function and QT interval ² , ⁵³⁰ , ⁵⁴⁸ , ⁵⁴⁹ , ⁵⁵⁰ , ⁵⁵¹ , ⁵⁵² , ⁵⁵³	IIa	B	B	II
Once oral use of pilsicainide, flecainide, propafenone or cibenzoline⁵ in patients with symptomatic parosyxmal AF in whom the risks of sinus rhythm recovery³ and use of Na⁺ channel blocker*⁴ have been denied ² , ¹¹⁰ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴	IIa	B	B	II
Use of amiodarone in persistent AF patients with heart failure or hypertrophic cardiomyopathy ² , ²³⁴ , ⁵³⁰ , ⁵⁵⁴ , ⁵⁵⁵	IIa	B	B	I
Combined use of aprindine with bepridil for persistent AF lasting >7 days ² , ⁵³⁰ , ⁵⁴⁸ , ⁵⁴⁹ , ⁵⁵⁰ , ⁵⁵¹ , ⁵⁵² , ⁵⁵³	IIb	C	B	III
Use of bepridil in persistent AF patients with ventricular dysfunction with normal QT interval ² , ⁵⁵² , ⁵⁵³	IIb	C	C1	IVb
Use of strong Na⁺ channel blockers*¹ in AF patients with ventricular dysfunction ² , ⁵³⁰ , ⁵⁴⁶	III	C	C2	IVb
Use of pharmacological defibrillation without pacing backup in patients in complicated with the risk of sinus rhythm recovery*³ ² , ⁵³⁰	III	C	C2	IVb
Use of Na⁺ channel blockers*¹ in patients with Brugada syndrome ² , ⁵³⁰	III	C	C2	IVb
Use of bepridil in persistent AF patients with QT prolongation ² , ⁵³⁰ , ⁵⁵² , ⁵⁵³	III	C	C2	IVb
Pharmacological defibrillation without appropriate antithrombotic strategy in AF patients whom the possibility of 48‐h continuation cannot be denied ² , ²¹ , ⁵³⁰	III	C	C2	IVb
Use of digoxin, sotalol as single use for the purpose of pharmacological defibrillation ² , ⁵³⁰ , ⁵³⁷ , ⁵³⁸ , ⁵⁵⁶	III	B	C2	II

*¹pilsicainide, cibenzoline, propafenone, flecainide. *²Confirmation of absence of intra‐atrial thrombus with transesophageal echocardiography or continuous appropriate anticoagulation >3 weeks. *³Possible appearance of sick sinus syndrome, AV block or bundle branch block after interruption of AF. *⁴Brugada syndrome or organic heart disease that might be affected by negative‐inotropic effect; history of atrial flutter. *⁵Efficacy and safety of the drug must be confirmed by doctor more than once.

AF, atrial fibrillation; AV, atrioventricular; COR, class of recommendation; GOR, grade of recommendation; LOE, level of evidence; MINDS, Medical Information Network Distribution Service.