A 60-year-old patient with recurrent paroxysmal AF and structural heart disease (EF 35%) requires rhythm control. Which antiarrhythmic is MOST appropriate?
- A Flecainide
- B Amiodarone ✓
- C Propafenone
- D Dronedarone
Correct answer: B. Amiodarone
Explanation
Amiodarone (Class III) is the only antiarrhythmic proven safe and effective for rhythm control in patients with structural heart disease and reduced EF. Class IC agents (flecainide, propafenone) are contraindicated in structural heart disease due to proarrhythmic risk demonstrated in the CAST trial. Dronedarone is contraindicated in permanent AF and in patients with recent decompensated heart failure or NYHA Class III-IV. Amiodarone, despite significant long-term toxicity, remains the drug of choice in this scenario.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.