Atrial fibrillation and the expanding role of catheter ablation: do antiarrhythmic drugs have a future?

The main therapeutic strategies for treating atrial fibrillation include rate control, maintenance of sinus rhythm, and antiembolic treatment. Current antiarrhythmic drugs are effective in about 50% of patients and are often associated with adverse effects. Multiple trials suggest that rate control with proper anticoagulation treatment is associated with a similar prognosis to a more aggressive rhythm control strategy. Catheter ablation of atrial fibrillation has success rates that exceed currently available antiarrhythmic drugs. However, catheter ablation is an evolving technique that can result in complications. In some patients, antiarrhythmic drugs are still required following ablation. New antiarrhythmic drug strategies include developing drugs that are more atrial selective, alteration of the multichannel blocking agent, amiodarone, or the development of drugs with novel mechanisms of action such as gap junction facilitation of conduction. Although catheter ablation procedures will continue to grow, the millions of atrial fibrillation patients who will require therapy will continue to make antiarrhythmic drug therapy an important part of our ongoing therapeutic armamentarium.