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spontaneous alternation between AF and sinus rhythm over short periods of time. (Level of evidence:C) 2)Additional cardioversion in patients with short period of sinus rhythm who relapse to AF display multiple cardioversion procedures and prophy lactic antiarrhythmic drug treatment. (Level of evidence:C) Table Typical doses of drugs used to maintain sinus rhythm in patients with atrial fibrillation Drug* Daily dosage** Potential adverse effects Admiodaro 100400mg Photosensitivity, pulmonary toxicity,poly neuropathy,GI upset,bradycaria,torsade de pointes (rare), hepatic toxicity,thyroid dysfunction Disopyramide 400750mg Torsade de pointes, HF, glaua, urinary retention, dry mouth Dofetilide 5001000ug Torsade de pointes Flecainide 200300mg Ventricular tachycardia, congestive HF, enhanced AV nodal conduction (conversion to atrial flutter) Procainamide 10004000mg Torsade de pointes, lupuslike syndrome, GI symptoms Propafenone 450900mg Ventricular tachycardia,congestive Hf, enhanced AV nodal conduction (conversion to atrial flutter) Quinidine 6001500mg Torsade de pointes, GI upset, enhanced AV nodal conduction Sotalol 240320mg Torsade de pointes, congestive HF, bradycardia, exacer bation of chronic obstructive of bronchospastic lung disease Table Pharmacological treatment before cardioversion in patients with Persistent atrial fibrillation: effects of various antiarrhythmic drugs on acute and subacute oute of transthoracic direct current shock Enhance conversion by DC Suppress SRAF and Remendation Level of Shock and prevent IRAF* maintenance therapy class evidence class Effective Amiodarone All drugs in re I B mendation Class I (except ibutilide) plus betablockers Flecainide Ibutilide Propafenone Propafenone+verapamil Quinidine Sotalol Uncertain/ Betablockers Diltiazem IIb B Unknown Disopyramide Dofetilide Diltiazem Verapamil Dofetilide Procainamide Verapamil 用索他洛爾、氟卡尼、最后用胺碘酮預防房顫 復發(fā),隨訪發(fā)現(xiàn): 1年維持竇律 42% 4年維持竇律 27% 服藥時間 1年或以上 CTAF( Canadian Trial of Atrial Fibrillation) 防止房顫復發(fā),隨訪 16個月 201例胺碘酮 202例索他洛爾或普羅帕酮 房顫復發(fā) 復發(fā)時間 1年后維持竇律 副作用 (中位數(shù)) 停藥 胺碘酮 71( 35%) 468天 69% 18% S or P 127( 63%) 98天 39% 11% P值 = Roy Detal. N Engl J Med 2021,342:913920 AFFIRM RACE Remendations for pharmacological therapy to maintain sinus rhythm Class I: 1)Base selection of pharmacological therapy to maintain sinus rhythm in patients with disabling or otherwise troublesome symptoms during AF predominantly on safety. (Level of evidence:B) 2)Treat precipitating or reversible cause of AF before initiation of antiarrhythmic drug therapy. (Level of evidence:C) Calss IIa: 1)Administer pharmacological therapy to maintain sinus rhythm to prevent progression of tachycardiainduced cardiomyopathy due to AF. (Level of evidence:C) 2)Infrequent and welltolerated recurrence of AF may in some cases be deemed a successful oute of anti arrhythmic drug therapy. (Level of evidence:C) 3)Outpatient initiation of antiarrhythmic drug treatment is appropriate in selected patients. (Level of evidence:C) Class IIb: 1)Administer pharmacological therapy to maintain sinus rhythm in asymptomatic patients to prevent atrial remo delling. (Level of Evidnece: C) 2)Administer pharmacological therapy to maintain sinus rhythm to prevent thromboembolism or HF in selected patients. (Level of evidence:C) 3)Administer binations of antiarrhythmic agents to maintain sinus rhythm when singledrug therapy fails. (Level of evidence:C) Class III: 1)Use of a particular pharmacological agent to maintain sinus rhythm in patients with welldefined proarrhythmia risk factors for th