Table 47.

Recommendation and Levels of Evidence for Pharmacological Prevention of AF Recurrence

	COR	LOE	GOR (MINDS)	LOE (MINDS)
Use of Na⁺ channel blockers^* for symptomatic recurrent AF without organic heart disease ² , ¹⁰⁹ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴	I	A	A	I
Use of amiodarone for recurrent AF with heart failure or hypertrophic cardiomyopathy ² , ²³⁴ , ⁵³⁰ , ⁵⁵⁶ , ⁵⁶⁶ , ⁵⁶⁸ , ⁵⁶⁹	I	B	B	II
Use of antiarrhythmic agent for the purpose of AF prevention when that drug has been effective for AF interruption ² , ¹¹⁰ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴	IIa	C	C1	III
Use of amiodarone or sotalol for recurrent AF complicated with organic heart disease other than heart failure and hypertrophic cardiomyopathy (not covered by insurance) ² , ²³⁵ , ⁵³⁰ , ⁵⁵⁶ , ⁵⁶⁹	IIa	B	B	I
Use of bepridil in symptomatic recurrent AF patients without organic heart disease in whom Na⁺ channel blocker^* has been ineffective ² , ⁵³⁰ , ⁵⁴⁸ , ⁵⁴⁹ , ⁵⁵⁰ , ⁵⁵¹ , ⁵⁵²	IIa	C	C1	III
Use of Na⁺ channel blockers^* for asymptomatic or less‐symptomatic recurrent AF without organic heart disease ² , ¹¹⁰ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴	IIb	C	C1	IVb
Use of Na⁺ channel blockers^* for recurrent AF complicated with atrial flutter without organic heart disease ² , ¹¹⁰ , ⁵³⁰ , ⁵³¹ , ⁵³² , ⁵³³ , ⁵³⁴ , ⁵³⁵ , ⁵³⁶ , ⁵⁴² , ⁵⁴³ , ⁵⁴⁴	IIb	C	C1	IVb
Use of antiarrhythmic agent for the purpose of AF prevention in cases of first‐diagnosed AF, alcohol‐related AF, or postoperative AF ² , ⁵³⁰ , ⁵⁶³ , ⁵⁶⁴ , ⁵⁶⁷ , ⁵⁶⁸	IIb	C	C1	IVb
Use of amiodarone in symptomatic recurrent AF patients without organic heart disease in whom Na⁺ channel blocker^* has been ineffective (not covered by insurance) ² , ²³⁵ , ⁵³⁰ , ⁵⁵⁶ , ⁵⁶⁸ , ⁵⁶⁹	IIb	B	A	I
Use of antiarrhythmic agent for brady/tachycardia syndrome without pacemaker implantation ² , ⁵³⁰	III	C	C2	IVb
Use of Na⁺ channel blockers^* for AF complicated with organic heart disease ² , ⁵³⁰ , ⁵⁷⁰	III	C	C2	IVb
Continuation of antiarrhythmic agent that is considered clinically ineffective ² , ⁵³⁰	III	C	C2	V
Use of Na⁺ channel blockers^* for AF complicated with Brugada syndrome ² , ⁵³⁰	III	C	C2	IVb
Use of K⁺ channel blockers for AF complicated with long QT syndrome ² , ²¹ , ⁵³⁰	III	C	C2	IVb

pilsicainide, cibenzoline, propafenone, flecainide. Use of these drugs should be avoided in cases of Brugada syndrome or organic heart disease that might be affected by negative‐inotropic effect, or with a history of atrial flutter.

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