title: Atrial fibrillation (chronic).
abstract: BACKGROUND
  Atrial fibrillation is a supraventricular tachyarrhythmia characterised by the presence of fast and uncoordinated atrial activation leading to reduced atrial mechanical function. Risk factors for atrial fibrillation include increasing age, male sex, co-existing cardiac and thyroid disease, pyrexial illness, electrolyte imbalance, cancer, and co-existing infection.
  
  
  METHODS
  We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral medical treatments to control heart rate in people with chronic (defined as longer than 1 week for this review) non-valvular atrial fibrillation? What is the effect of different treatment strategies (rate versus rhythm) for people with persistent non-valvular atrial fibrillation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
  
  
  RESULTS
  We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
  
  
  CONCLUSIONS
  In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta-blockers (with or without digoxin), calcium channel blockers (with or without digoxin), calcium channel blockers (rate-limiting), digoxin, and rate versus rhythm control strategies.
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Lane
authors.forename: Stavros
authors.initials: S
authors.lastname: Apostolakis
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Boos
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001281:Atrial Fibrillation; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases; D004077:Digoxin / Q000627:therapeutic use; D006801:Humans
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D004077:Digoxin
references.citation: Am Heart J. 2005 Jan;149(1):112-20
references.pmid: 15660042
references.citation: Scott Med J. 2005 Nov;50(4):166-9
references.pmid: 16374981
references.citation: Arch Intern Med. 2005 Feb 14;165(3):258-62
references.pmid: 15710787
references.citation: Stroke. 1991 Mar;22(3):312-8
references.pmid: 2003301
references.citation: Am J Cardiol. 2007 Jul 15;100(2):247-52
references.pmid: 17631079
references.citation: Int J Cardiol. 1995 Nov 24;52(2):167-74
references.pmid: 8749878
references.citation: Chest. 2004 Aug;126(2):476-86
references.pmid: 15302734
references.citation: J Am Coll Cardiol. 2003 Dec 3;42(11):1944-51
references.pmid: 14662257
references.citation: Health Technol Assess. 2005 Oct;9(40):iii-iv, ix-x, 1-74
references.pmid: 16202350
references.citation: N Engl J Med. 2002 Dec 5;347(23):1834-40
references.pmid: 12466507
references.citation: Chest. 1998 Nov;114(5 Suppl):579S-589S
references.pmid: 9822064
references.citation: Eur Heart J. 2006 Apr;27(8):949-53
references.pmid: 16527828
references.citation: Chest. 1983 Mar;83(3):491-9
references.pmid: 6337787
references.citation: Jpn Heart J. 2004 Jul;45(4):591-601
references.pmid: 15353870
references.citation: J Am Coll Cardiol. 2005 Nov 15;46(10):1891-9
references.pmid: 16286177
references.citation: Stroke. 1996 Oct;27(10):1765-9
references.pmid: 8841326
references.citation: Heart. 2001 Nov;86(5):516-21
references.pmid: 11602543
references.citation: Am J Med. 2006 May;119(5):448.e1-19
references.pmid: 16651058
references.citation: Circulation. 1998 Sep 8;98(10):946-52
references.pmid: 9737513
references.citation: Eur Heart J. 2005 Oct;26(19):2000-6
references.pmid: 15872032
references.citation: Circulation. 2006 Aug 15;114(7):e257-354
references.pmid: 16908781
references.citation: Br J Clin Pharmacol. 2005 Oct;60(4):347-54
references.pmid: 16187966
references.citation: J Am Coll Cardiol. 2004 Jan 21;43(2):241-7
references.pmid: 14736444
references.citation: Lancet. 2000 Nov 25;356(9244):1789-94
references.pmid: 11117910
references.citation: Circulation. 2006 Jul 11;114(2):119-25
references.pmid: 16818816
references.citation: Circ J. 2008 May;72(5):705-8
references.pmid: 18441447
references.citation: Heart. 2009 Jun;95(11):924-30
references.pmid: 19282313
references.citation: J Am Coll Cardiol. 2003 May 21;41(10):1690-6
references.pmid: 12767648
references.citation: Eur Heart J. 2010 Oct;31(19):2369-429
references.pmid: 20802247
references.citation: N Engl J Med. 2008 Jun 19;358(25):2667-77
references.pmid: 18565859
references.citation: Circulation. 2004 Aug 31;110(9):1042-6
references.pmid: 15313941
references.citation: Am J Cardiol. 1998 Oct 16;82(8A):2N-9N
references.pmid: 9809895
references.citation: N Engl J Med. 2002 Dec 5;347(23):1825-33
references.pmid: 12466506