propafenone + sotalol + flecainide

This is a combination of three antiarrhythmic drugs—propafenone, sotalol, and flecainide—used in the management of highly refractory atrial fibrillation (AF) or other arrhythmias. Propafenone and flecainide are classified as Class Ic antiarrhythmic agents that primarily block the cardiac fast inward sodium current (INa), slowing intracardiac conduction and prolonging atrial refractoriness. Sotalol is a Class III antiarrhythmic agent with additional non-selective beta-blocker activity; it works by blocking potassium channels, thereby prolonging cardiac action potential duration and refractory period. The combined use of these agents has been reported in select cases for patients who have failed multiple standard therapies for AF, but such combinations require careful inpatient monitoring due to increased risk of proarrhythmia[1][2]. This regimen is not standard practice and should only be considered under specialist supervision.