Pharmacologic antiarrhythmic therapy is the most commonly used treatment in most patients
with atrial fibrillation (AF), but currently available agents are limited by risks
that may offset the benefits of sinus rhythm. The development of antiarrhythmic agents
with the potential for fewer adverse ventricular effects and less extracardiac toxicity
is a primary aim of current investigations. At present, pharmacologic research is
actively focused on developing antiarrhythmic agents with multiple or novel ion channel
effects. There are 4 agents that act by simultaneously blocking multiple ion channels
that are currently under regulatory review: azimilide dihydrochloride, tedisamil,
dronedarone, and vernakalant (RSD-1235). In addition, agents with mechanisms of action
that differ from those of existing agents (eg, gap junction modulators) are under
review, as is the use of nonantiarrhythmic agents (eg, renin–angiotensin system antagonists,
statins, n-3 polyunsaturated fatty acids) to alter the cardiac substrate and suppress AF in
some patient subtypes.
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© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
