Atrial fibrillation - cardioversion: amiodarone + flecainide

Atrial fibrillation - cardioversion: amiodarone + flecainide

If a patient is haemodynamically unstable electrical cardioversion is required but pharmacological cardioversion is often performed on stable patients and may be useful in determining which ‘pill-in-the-pocket’ drug is most suitable.

In younger patients a rhythm control strategy is more likely to be used. If it is decided to simply control the rate then beta-blockers, calcium channel blockers or digoxin may be used.

Atrial fibrillation: pharmacological cardioversion

The Royal College of Physicians and NICE published guidelines on the management of atrial fibrillation (AF) in 2006. The following is also based on the joint American Heart Association (AHA), American College of Cardiology (ACC) and European Society of Cardiology (ESC) 2012 guidelines

Agents with proven efficacy in the pharmacological cardioversion of atrial fibrillation

• amiodarone
• flecainide (if no structural heart disease)
• others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone

Less effective agents

• beta-blockers (including sotalol)
• calcium channel blockers
• digoxin
• disopyramide
• procainamide