From the Guidelines
The primary goal of anti-arrhythmic medication is to improve symptoms and quality of life, rather than solely to maintain cardiac output or restore normal rhythm. The aim of antiarrhythmic drug therapy is improvement in arrhythmia-related symptoms, as stated in the 2016 ESC guidelines for the management of atrial fibrillation 1. While maintaining adequate cardiac output is crucial, the primary objective of anti-arrhythmic medication is to reduce the frequency of symptoms and improve quality of life in selected patients, as noted in the 2017 update to practice standards for electrocardiographic monitoring in hospital settings 1. Key considerations in the use of anti-arrhythmic drugs include:
- The efficacy of these drugs in maintaining sinus rhythm is modest
- Clinically successful antiarrhythmic drug therapy may reduce rather than eliminate the recurrence of arrhythmias
- Safety rather than efficacy considerations should primarily guide the choice of antiarrhythmic drug, due to the risk of proarrhythmias and extracardiac side-effects 1. Some anti-arrhythmic drugs, such as amiodarone, sotalol, and dofetilide, have been shown to reduce recurrences of atrial tachyarrhythmias after cardioversion, but their use must be carefully considered due to the risk of adverse effects 1. Ultimately, the decision to initiate long-term antiarrhythmic drug therapy should balance symptom burden, possible adverse drug reactions, and patient preferences, with the goal of improving quality of life and reducing symptoms.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Goal of Anti-Arrhythmic Medication
The goal of anti-arrhythmic medication is to:
- Maintain cardiac output
- Restore the rhythm to normal, specifically in the case of atrial fibrillation (AF) where the goal is to maintain sinus rhythm, reduce symptoms, improve exercise tolerance, and improve quality of life 2
Mechanism of Action
Anti-arrhythmic drugs (AADs) work by:
- Reducing the heart rate to a normal range, which can be achieved through rate control strategies using beta-blockers or calcium channel blockers 3, 4, 5, 6
- Converting the abnormal heart rhythm back to a normal sinus rhythm, which can be achieved through rhythm control strategies using AADs such as amiodarone, disopyramide, dofetilide, flecainide, propafenone, and sotalol 2
Comparison of Rate Control Strategies
Studies have compared the efficacy of different rate control strategies, including:
- Beta-blockers versus calcium channel blockers, with some studies suggesting that beta-blockers may be more effective in reducing heart rate and shortening hospitalization duration 3, while others have found no significant difference between the two 4, 5
- The use of concomitant parenteral calcium channel blockers and beta blockers, which has been shown to be effective in achieving rate control in patients with rapid atrial fibrillation or flutter 6