Which medication is most appropriate for a patient with paroxysmal atrial fibrillation and coronary artery disease?

Dronedarone is the most appropriate medication for a patient with paroxysmal atrial fibrillation and coronary artery disease because it is designed to reduce the risk of cardiovascular events in patients with atrial fibrillation and concomitant heart disease. Dronedarone is structurally similar to amiodarone but has a more favorable side effect profile, primarily due to its lack of iodine, which reduces the risk of thyroid and pulmonary toxicity associated with amiodarone.

Additionally, dronedarone has been shown to improve outcomes in patients with atrial fibrillation while also providing antiarrhythmic effects similar to those of amiodarone, but without some of the more severe adverse effects. This makes it a suitable choice for patients who may have underlying coronary artery disease, providing both rhythm control while minimizing potential complications associated with other antiarrhythmic agents.

Other medications, while effective for atrial fibrillation, may pose greater risks or be less appropriate in the context of coronary artery disease. For instance, both flecainide and propafenone are generally avoided in patients with structural heart disease, including coronary artery disease, as they can potentially exacerbate cardiac conditions or lead to proarrhythmia. Amiodarone