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Class IV drugs in atrial fibrillation

Authoring team

Drugs such as verapamil and diltiazem increase the refractory period of the atrioventricular node and so control the ventricular response to atrial fibrillation.

Disadvantages of verapamil include:

  • a lower rate of conversion to sinus rhythm than with class IV or class I drugs
  • a danger of malignant ventricular arrhythmias if there is underlying Wolff-Parkinson-White syndrome
  • a lack of efficacy in paroxysmal atrial fibrillation

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