AAD

In general, when choosing an AAD for symptomtic atrial fibrillation, the
following should be taken into consideration:
        (a) Are there any secondary triggers of AFib that can be minimized to
            help improve the chances of staying in sinus rhythm.  These include:
                -Obstructive Sleep Apnea (OSA)
                        -Ideally, the AHI should be < 5
                -Hypertension
                -Correlation with EToH consumption
                -Thyroid Disease
                -Pulmonary Disease / Hypoxia
                -Infection
        (b) If patient has no evidence of structural heart disease / CAD and
            overall pretest probability / suspicion for CAD is low, Class IC
            AADs are a consideration (Flecainide)
                -Contraindications to Flecainide include:
                        -LVH > 1.4 cm
                        -2nd or 3rd degree AV Block (unless PPM)
                        -Bifascicular block (unless they have a PPM)
                        -Concurrent use of Ritonavir
                        -Significant hepatic impairment
                        -Significant renal impairment
                -As flecainide is a use dependent AAD, would recommend obtaining
                treadmill ECG to examine QRS duration at elevated heart rates
        (c) Presence of Structural Heart Disease / CAD precludes the use of
            Class IC AAD, and thus leaves us with the following choices:
                -Amiodarone
                -Sotalol
                -Dofetilide