Class Ia and III drugs may be effective if the arrhythmia depends on shortening of refractoriness. Class Ic drugs may act by suppressing arrhythmogenic premature beats or by rate-dependent prolongation of refractoriness. Crijns et al suggested that such a strategy, in combination with electrical recardioversion in resistant cases, may reduce the recurrence rate from 50% to approximately 35%. Although several drugs are effective in the maintenance of sinus rhythm, no agent is perfect, and the decision to use a particular drug should aside from personal preference and depends on the side effect profile and the characteristics of the patient being treated.
Study limitations: Our trial was designed to compare diso-pyramide, propafenone and sotalol, and did not have a control group. The trial was nonblinded, and each study group was relatively small.
The efficacy and safety of disopyramide, propafenone and sotalol in maintaining sinus rhythm after successful DC cardioversion of chronic AF was similar during 12 months of follow-up. Larger randomized trials are needed to determine the proper role of these agents in comparison with that of conventional therapy in the management of patients with AF.
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