HEART RHYTHM CONTROL STRATEGY

 

HEART RHYTHM CONTROL STRATEGY:

CLASS IC
Flecainide	50 - 150 mg PO bid * Combine with AV node blocking agent	• Efficacy at 1 year: 30-50 % • Adverse effects: ↑QRS (caution if > 25%); VT; bradycardia; 1:1 flutter • Contraindications: CAD or LV dysfunction (★ CAST) • Pre-treatment stress test if > 50 years or high Framingham score
Propafenone	50 - 300 mg PO tid * Combine with AV node blocking agent
CLASSE III
Amiodarone	Loading dose of 10 g over several weeks then 100 - 200 mg PO qd	• Efficacy at 1 year: 60-70 % (★ CTAF) • Avantage: controls HR (BB effect) • Adverse effects: ⏭ Amiodarone
Dronedarone	400 mg PO bid	• Efficacy at 1 year: 40 % • ★ ATHENA: Paroxysmal AF; ↘ cardiac mortality with Dronedarone • Contraindications: heart failure / LVEF < 40% (★ ANDROMEDA) or permanent AF (★ PALLAS) or Digoxin • Monitor LFTs at 6 months
Sotalol	40 - 160 mg PO bid	• Efficacy at 1 year: 30-50 % (★ CTAF) • Adverse effects: ↗ QT; torsade de pointes; bradycardia; asthma (BB effect) • Avoid: women > 65 years / CRF / LVEF < 40% / significant LVH / electrolyte disorders / ↗ QTc • Monitoring of QT for 72 h; stop if QTc > 500 ms
Dofetilide	0.125 to 0.5 mg PO bid (according to CrCl)	• Complication: torsade de pointes • Contraindications: CrCl < 20 mL/min; hypokalemia; baseline QTc > 440 ms