Cardioversion of recent-onset atrial fibrillation using intravenous
antiarrhythmics
Abstract
ABSTRACT (195 words) Pharmacological cardioversion using intravenous
antiarrhythmic agents is commonly indicated in symptomatic patients with
recent-onset atrial fibrillation (AF). Except in hemodynamically
unstable patients who require emergency direct current electrical
cardioversion, for the majority of hemodynamically stable patients,
pharmacological cardioversion represents a valid option and requires the
clinician to be familiar with the properties and use of antiarrhythmic
agents. The main characteristics of selected intravenous antiarrhythmic
agents for conversion of recent-onset AF, the reported success rates and
possible adverse events are discussed. Among intravenous
antiarrhythmics, flecainide, propafenone, amiodarone, sotalol,
dofetilide, ibutilide and vernakalant are commonly used. Antazoline, an
old antihistaminic agent with antiarrhythmic properties was also
reported to give encouraging results. Intravenous flecainide and
propafenone are the only class I agents still recommended by recent
guidelines. Intravenous new class III agents as dofetilide and ibutilide
have high and rapid efficacy in converting AF to sinus rhythm but
require strict surveillance with ECG monitoring during and after
intravenous administration because the potential risk of QT prolongation
and Torsades de Pointes which can be prevented and properly managed.
Vernakalant, a partial atrial selective was shown to have a high success
rate and to be safe in real life use.