Antiarrhythmic drugs in atrial fibrillation: do they have a future?

Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity and mortality. There has been much debate about the relative merits of rate vs rhythm control strategies, and studies to date have failed to show advantage with a rhythm-control strategy using antiarrhythmic drugs (AADs). This is likely because of the inadequacies of our current AADs and the limitations of study designs. However, there is evidence that AADs improve symptoms and quality of life (QOL). Until trials are performed with more appropriate patient selection, and end points and better AADs and strategies for their use, rhythm control should not be abandoned and may continue to be beneficial in selected patients.