Franken RA et al. Atrial fibrillation in the elderly 95 Figure 2. Decision for cardioversion to sinus rhythm. AF: Atrial fibrillation; HR: heart rate. Figure 3. Using of antiarrhythmic drugs after reverse to sinus rhythm. LVH: Left ventricular hypertrophy. sotalol is indicated; and for those with systolic dysfunction or ventricular hypertrophy, amiodarone is indicated. One should note that, dronedarone use has been based on studies with approximately 6300 patients.[58] Dronedarone is an antiarrhythmic similar to amiodarone but lacks an iodine moiety. Two studies (EURIDIS and ADONIS)[59,60] have observed that dronedarone does not improve the results of electrical cardioversion in AF patients and dronedarone is less effective than amiodarone for sinus rhythm reversion. The ATHENA study,[61] including 4,624 older people receiving dronedarone or placebo, has observed longer survival and lower number of hospitalizations in patients receiving the drug. The results suggest antiarrhrythmic drugs may decrease mortality and morbidity in patients with non-permanent AF. On the other hand, the Pallas study, including just permanent AF patients, was interrupted in phase 3 due to the increased number of cardiovascular complications in the dronedarone arm.[62] According to recent guidelines updates, dronedarone is indicated to decrease hospitalization in paroxysmal AF patients, or after electrical cardioversion (indication II evidence level B). The drug should not be used in patients with HF class IV, if there has been heart decompensation in the last 30 days, or when the ejection fraction is lower than 35%. In addition to drugs, other triggering factors for arrhythmia, such as alcohol, stress, thyroid diseases, etc., should also be ruled out. Non-antiarrhythmic drugs, such as angiotensin II converting http://www.jgc301.com; jgc@mail.sciencep.com | Journal of Geriatric Cardiology