Pharmacological rhythm control strategy for atrial fibrillation

: Rhythm control therapy improves the quality of life in properly selected patients with atrial fibrillation (AF). Sodium channel blockers are recommended as a first-line therapy for lone paroxysmal AF. Pilsicainide, a pure sodium channel blocker is the most frequently used drug in Japan. In addition to amiodarone, several reports performed in Japan described defibrillating effect of bepridil. These two drugs are considered as first choice for rhythm control treatment to lone persistent AF. Since sodium channel blockers increase mortality in patients with reduced cardiac function, amiodarone or bepridil are recommended for rhythm control in AF accompanied with structural heart disease. However, sufficient treatment for underlying heart disease is required prior to administration of antiarrhythmic drugs.