Drug therapy for atrial fibrillation: what will its role be in the era of increasing use of catheter ablation?

Atrial fibrillation (AF) is an increasingly important disorder. In most patients the treatment of AF usually employs anti-arrhythmic drugs (AADs). Despite the widespread utilization of AADs for the conversion of atrial fibrillation and maintenance of normal sinus rhythm, their use is limited by modest efficacy, frequent intolerance, and the potential for serious ventricular proarrhythmia and organ toxicity. In addition to AADs, ablations for AF have come into vogue. If ablation techniques improve, one might ask whether there will still be a role for AADs, and, if so, what will it be and what agents will be used. This manuscript will attempt to answer these questions.