Pharmacotherapy for atrial arrhythmias: present and future

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. It is associated with significant morbidity, including palpitations, exercise intolerance, congestive heart failure, and increased risk of embolic stroke. Mortality is increased twofold in patients with AF. Management of AF with antiarrhythmic drugs traditionally has been hindered by lack of efficacy, poor tolerance of side effects, drug-associated toxicity, and proarrhythmic potential. Improved understanding of atrial electrical and structural remodeling as well as advances in rational drug design have led to new agents that may be superior to their predecessors. New agents that target atrium-specific ion channels limit the potential for ventricular arrhythmias, and less toxic derivatives such as dronedarone may be more tolerable. Drugs with entirely novel mechanisms, such as the gap junction modulator rotigaptide, have shown efficacy in ventricular arrhythmias and have potential for atrial arrhythmias as well. This review discusses recent advances in pharmacotherapy for treatment of atrial arrhythmias.