Over the last decade, several rhythm-versus rate-control trails in patients with atrial fibrillation (AF) have failed to demonstrate benefit of the rhythm control strategy with respect to mortality and morbidity. This had let to the guideline recommendation that antiarrhythmic drug therapy should be considered predominantly for sympt0matic improvement of patients. Recent trails and meta-analyses have demonstrated that amiodarone is the most antiarrhythmic drug currently available. However, its use has been associated with many adverse effects. Currently, dronedarone is the only available antiarrhythmic drug which has shown a reduction in cardiovascular hospitalizations in medium-risk AF patients. However, the drug was associated with increased mortality in patients with recently decompensated heart failure. Hence, antiarrhythmic drug therapy has to be evaluated in patients with AF on an individual patients basis.

Dr. Hohnloser received an honorarium through an educational grant from Sanofi Aventis for time and expertise spent writing this article. Dr. Hohnloser reports receiving consulting fees from Bayer, BMS; Cardiome, Pfizer, MSD, and Sanofi Aventis; research grants from Sanofi Aventis and St. Jude Medical, and lecture fees from BMS, Cardiome, Medtronic, Sanofi Aventis, and St. Jude Medical.