Is amiodarone the best antiarrhythmic?

Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin . Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation.

These treatments are sometimes called chemical cardioversion: Sodium channel blockers , which slow your heart’s ability to conduct electricity: Flecainide (Tambocor) Propafenone (Rythmol)

It is the most effective antiarrhythmic drug currently available but is limited by a myriad of noncardiovascular side effects21 (Table 1). The major cardiovascular side effect of amiodarone is sinus bradycardia, with a higher risk of pacemaker requirement in women.

Although the U.S. Food and Drug Administration (FDA) has labeled amiodarone only for the treatment of life-threatening ventricular arrhythmias, the drug also is used to treat atrial fibrillation .