DRUGS FOR CONVERSION OF ATRIAL-FIBRILLATION

Atrial fibrillation is the most common arrhythmia in patients visiting a primary care practice. Although many patients with atrial fibrillat ion experience relief of symptoms with control of the heart rate, some patients require restoration of sinus rhythm. External direct current (DC) cardioversion is the most effective means of converting atrial f ibrillation to sinus rhythm. Pharmacologic cardioversion, although les s effective, offers an alternative to DC cardioversion. Several advanc es have been made in antiarrhythmic medications, including the develop ment of ibutilide, a class III antiarrhythmic drug indicated for acute cardioversion of atrial fibrillation. Other methods of pharmacologic and nonpharmacologic cardioversion remain tinder development. Until th e results of several large-scale randomized clinical trials are availa ble, the decision to choose cardioversion or maintenance of sinus rhyt hm must be individualized, based on relief of symptoms and reduction o f the morbidity and mortality associated with atrial fibrillation.