Atrial fibrillation: initiation of antiarrhythmic therapy should always be performed on an inpatient basis

Summary:

Atrial fibrillation is the most common clinically encountered arrhythmia; which is often trated by antiarrhythmic drugs. Within the last ten years many studies concerning the application of class I and class III antiarrhythmic drugs in patients with atrial fibrillation have shown a considerable risk of proarrhythmia. Especially in patients with structural heart disease and impaired left ventricular function, severe proarrhythmic side effects as asystole, torsade de pointes tachycardia or ventricular fibrillation are observed. These proarrhythmic hazards are reported to occur mostly within the first four days after initiation of therapy.

As there are no data from large prospective clinical trials focusing on cardiac mortality and proarrhythmia in patients with atrial fibrillation, antiarrhythmic therapy with class I or class III antiarrhythmic agents for atrial fibrillation should always be performed on an inpatient basis for at least four days.