Maintaining sinus rhythm

• an antiarrhythmic drug is not required to maintain sinus rhythm in patients with persistent AF in whom a precipitant (such as chest infection or fever) has been corrected and cardioversion has been performed successfully, providing there are no risk factors for recurrence
  
  
• drug treatment for long-term rhythm control if drug treatment for long-term rhythm control is needed, consider a standard beta-blocker (that is, a beta-blocker other than sotalol) as first-line treatment unless there are contraindications if beta-blockers are contraindicated or unsuccessful, assess the suitability of alternative drugs for rhythm control, taking comorbidities into account Dronedarone is recommended as an option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation: Consider amiodarone for people with left ventricular impairment or heart failure Do not offer class 1c antiarrhythmic drugs such as flecainide or propafenone to people with known ischaemic or structural heart disease
  • whose atrial fibrillation is not controlled by first-line therapy (usually including beta-blockers), that is, as a second-line treatment option and after alternative options have been considered and
  • who have at least 1 of the following cardiovascular risk factors:
    • hypertension requiring drugs of at least 2 different classes
    • diabetes mellitus
    • previous transient ischaemic attack, stroke or systemic embolism
    • left atrial diameter of 50 mm or greater
    • or age 70 years or older and
  • who do not have left ventricular systolic dysfunction and
  • who do not have a history of, or current, heart failure
    
    

Reference:

1. NICE (April 2021). Atrial Fibrillation