[Antiarrhythmic drugs in atrial fibrillation]

Antiarrhythmic drugs in atrial fibrillation are relatively old and have well-specified indications. Class I antiarrhythmic drugs (IA: quinidine, disopyramide; IC: cibenzoline, flecainide, propafenone) are first indicated in patients without history of myocardial infarction and heart failure. In this last case, a b-blocker or amiodarone are indicated. Amiodarone is also indicated after failure of class I antiarrhythmic drugs. The association of class I antiarrhythmic drugs or amiodarone with a small dose of b-blocker is suitable if possible. However, the association of amiodarone with half-dose of a class I antiarrhythmic drug should remain rare, because the prognosis of chronic atrial fibrillation is unknown; the benefits to risks ratio of antiarrhythmic treatment should be discussed for each patient.