1. Amiodarone (Long-Term Use)While effective for rhythm control, long-term use of amiodarone is linked to thyroid dysfunction, lung toxicity, and liver damage, making it a less favorable option.

2. DigoxinOnce commonly prescribed for rate control, digoxin is now discouraged due to its narrow therapeutic window, risk of toxicity, and potential for increasing mortality in AFib patients.

3. DronedaroneA relative of amiodarone, dronedarone has been associated with severe liver injury and is less effective for maintaining sinus rhythm.

4. Flecainide (in Structural Heart Disease)Flecainide is avoided in patients with structural heart disease due to an increased risk of proarrhythmic effects, potentially worsening heart conditions.

5. Propafenone (in Structural Heart Disease)Similar to flecainide, propafenone should be avoided in structural heart disease patients due to proarrhythmic risks.

6. Aspirin (for Stroke Prevention in AFib)Aspirin alone is no longer recommended for stroke prevention in AFib due to its limited efficacy compared to newer anticoagulants.

7. Warfarin (When DOACs Are an Option)While effective, warfarin requires frequent monitoring and dietary restrictions. Direct oral anticoagulants (DOACs) are now preferred for most AFib patients.

8. SotalolSotalol, used for rhythm control, can cause serious side effects, including QT prolongation and torsades de pointes, especially in older adults.

9. QuinidineAn older antiarrhythmic, quinidine has largely fallen out of favor due to its side effects, including gastrointestinal issues and proarrhythmic risks.

10. Verapamil (in Heart Failure with Reduced Ejection Fraction)Verapamil, a calcium channel blocker, should be avoided in AFib patients with heart failure due to its negative inotropic effects, which can worsen heart function.