title: The evidence regarding the drugs used for ventricular rate control.
abstract: OBJECTIVE
  Our goal was to determine what drugs are most efficacious for controlling the ventricular rate in patients with atrial fibrillation.
  
  
  METHODS
  We conducted a systematic review of the literature published before May 1998, beginning with searches of The Cochrane Collaboration's CENTRAL database and MEDLINE.
  
  
  METHODS
  We included English-language articles describing randomized controlled trials of drugs used for heart rate control in adults with atrial fibrillation.
  
  
  METHODS
  Abstracts of trials were reviewed independently by 2 members of the study team. We reviewed English-language abstracts of non-English-language publications to assess qualitative consistency with our results.
  
  
  RESULTS
  Forty-five articles evaluating 17 drugs met our criteria for review. In the 5 trials of verapamil and 5 of diltiazem, heart rate was reduced significantly (P <.05), both at rest and with exercise, compared with placebo, with equivalent or improved exercise tolerance in 6 of 7 comparisons. In 7 of 12 comparisons of a beta-blocker with placebo, the beta-blocker was efficacious for control of resting heart rate, with evidence that the effect is drug specific, as nadolol and atenolol proved to be most efficacious. All 9 comparisons demonstrated good heart rate control with beta-blockers during exercise, although exercise tolerance was compromised in 3 of 9 comparisons. In 7 of 8 trials, digoxin administered alone slowed the resting heart rate more than placebo, but it did not significantly slow the rate during exercise in 4 studies. The trials evaluating other drugs yielded insufficient evidence to support their use, but those drugs may yet be promising.
  
  
  CONCLUSIONS
  The calcium-channel blockers verapamil or diltiazem, or select beta-blockers are efficacious for heart rate control at rest and during exercise for patients with atrial fibrillation without a clinically important decrease in exercise tolerance. Digoxin is useful when rate control during exercise is less a concern.
authors.affiliation: The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Segal
authors.forename: R L
authors.initials: RL
authors.lastname: McNamara
authors.forename: M R
authors.initials: MR
authors.lastname: Miller
authors.forename: N
authors.initials: N
authors.lastname: Kim
authors.forename: S N
authors.initials: SN
authors.lastname: Goodman
authors.forename: N R
authors.initials: NR
authors.lastname: Powe
authors.forename: K
authors.initials: K
authors.lastname: Robinson
authors.forename: D
authors.initials: D
authors.lastname: Yu
authors.forename: E B
authors.initials: EB
authors.lastname: Bass
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D015982:Bias; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D004110:Diltiazem / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015444:Exercise; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D012107:Research Design / Q000592:standards*; D012146:Rest; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects*; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D004077:Digoxin; D014700:Verapamil; D004110:Diltiazem