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Class IV drugs in atrial fibrillation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Drugs such as verapamil and diltiazem increase the refractory period of the atrioventricular node and so control the ventricular response to atrial fibrillation.

Disadvantages of verapamil include:

  • a lower rate of conversion to sinus rhythm than with class IV or class I drugs
  • a danger of malignant ventricular arrhythmias if there is underlying Wolff-Parkinson-White syndrome
  • a lack of efficacy in paroxysmal atrial fibrillation

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