In managing a patient with paroxysmal atrial fibrillation without structure heart disease, which drug can be initiated for maintenance of rhythm?

Flecainide is a class IC antiarrhythmic medication that is commonly used for the maintenance of rhythm in patients with paroxysmal atrial fibrillation, especially in those without structural heart disease. The rationale for choosing flecainide in this patient population lies in its efficacy for rhythm control, as well as its safety profile in those without significant structural heart abnormalities.

Flecainide works by blocking sodium channels, which stabilizes the cardiac cell membrane and helps to prevent the re-entrant circuits that cause atrial fibrillation. It has been shown to be effective in restoring and maintaining sinus rhythm in patients with paroxysmal atrial fibrillation.

While amiodarone is often used for rhythm control due to its effectiveness in various arrhythmias, it comes with a broader side effect profile and is typically not the first-line agent for maintenance therapy in patients without structural heart disease. Sotalol is another option, but it has a risk of inducing torsades de pointes, especially in patients who may have impaired renal function. Dronedarone, while also an option for atrial fibrillation, has limitations in efficacy compared to flecainide and is generally not recommended in patients with a history of prior