title: Current Evidence and Recommendations for Rate Control in Atrial Fibrillation.
abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, which is associated with substantial risk of stroke and thromboembolism. As an arrhythmia that is particularly common in the elderly, it is an important contributor towards morbidity and mortality. Ventricular rate control has been a preferred and therapeutically convenient treatment strategy for the management of AF. Recent research in the field of rhythm control has led to the advent of newer antiarrhythmic drugs and catheter ablation techniques as newer therapeutic options. Currently available antiarrhythmic drugs still remain limited by their suboptimal efficacy and significant adverse effects. Catheter ablation as a newer modality to achieve sinus rhythm (SR) continues to evolve, but data on long-term outcomes on its efficacy and mortality outcomes are not yet available. Despite these current developments, rate control continues to be the front-line treatment strategy, especially in older and minimally symptomatic patients who might not tolerate the antiarrhythmic drug treatment. This review article discusses the current evidence and recommendations for ventricular rate control in the management of AF. We also highlight the considerations for rhythm control strategy in the management of patients of AF.
authors.affiliation: Research Fellow.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Maan
authors.affiliation: Associate Professor of Medicine.
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
authors.affiliation: Associate Professor of Medicine.
authors.forename: Jeremy
authors.initials: J
authors.lastname: N Ruskin
authors.affiliation: Assistant Professor of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, US.
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
keywords: Atrial fibrillation; beta-blockers; rate control
references.citation: N Engl J Med. 2010 Apr 15;362(15):1363-73
references.pmid: 20231232
references.citation: Am J Cardiol. 1998 Mar 1;81(5):594-8
references.pmid: 9514456
references.citation: Eur Heart J. 2004 Sep;25(17):1542-9
references.pmid: 15342174
references.citation: N Engl J Med. 2002 Dec 5;347(23):1825-33
references.pmid: 12466506
references.citation: Heart Rhythm. 2010 Sep;7(9):1171-7
references.pmid: 20430112
references.citation: J Am Coll Cardiol. 2001 Feb;37(2):371-8
references.pmid: 11216949
references.citation: Heart Rhythm. 2010 Sep;7(9):1178-83
references.pmid: 20206328
references.citation: J Cardiovasc Electrophysiol. 2008 Jul;19(7):661-7
references.pmid: 18284502
references.citation: J Am Coll Cardiol. 2011 Mar 15;57(11):e101-98
references.pmid: 21392637
references.citation: Am J Med. 1995 May;98(5):476-84
references.pmid: 7733127
references.citation: J Am Coll Cardiol. 1998 Mar 1;31(3):637-44
references.pmid: 9502647
references.citation: JAMA. 2010 Jan 27;303(4):333-40
references.pmid: 20103757
references.citation: Europace. 2011 Oct;13(10):1375-85
references.pmid: 21757483
references.citation: Cardiology. 1997 Jul-Aug;88(4):323-7
references.pmid: 9197425
references.citation: Circ J. 2007 Jun;71(6):936-40
references.pmid: 17526993
references.citation: N Engl J Med. 2000 Mar 30;342(13):913-20
references.pmid: 10738049
references.citation: J Cardiovasc Electrophysiol. 2013 Jul;24(7):731-8
references.pmid: 23551460
references.citation: Int J Cardiol. 2013 Sep 10;167(6):2600-4
references.pmid: 22781508
references.citation: Circulation. 2004 Mar 30;109(12):1509-13
references.pmid: 15007003
references.citation: Int J Cardiol. 2013 Sep 30;168(2):1280-5
references.pmid: 23269316
references.citation: Arch Cardiovasc Dis. 2012 Apr;105(4):226-38
references.pmid: 22633297
references.citation: Arch Intern Med. 2005 Feb 14;165(3):258-62
references.pmid: 15710787
references.citation: Am Heart J. 1996 Mar;131(3):499-507
references.pmid: 8604629
references.citation: Pacing Clin Electrophysiol. 2013 Jan;36(1):122-33
references.pmid: 22978656
references.citation: J Am Coll Cardiol. 2004 Apr 7;43(7):1201-8
references.pmid: 15063430
references.citation: Can J Cardiol. 2011 Jan-Feb;27(1):47-59
references.pmid: 21329862
references.citation: Cardiovasc Res. 1999 May;42(2):470-6
references.pmid: 10533582
references.citation: Lancet. 2000 Nov 25;356(9244):1789-94
references.pmid: 11117910
references.citation: J Am Coll Cardiol. 2013 Jan 29;61(4):455-460
references.pmid: 23265334
references.citation: Br J Clin Pharmacol. 2005 Oct;60(4):347-54
references.pmid: 16187966
references.citation: J Cardiovasc Electrophysiol. 2005 Nov;16(11):1160-5
references.pmid: 16302897
references.citation: Am Heart J. 2002 Jun;143(6):984-90
references.pmid: 12075253
references.citation: Circulation. 2012 Dec 4;126(23):2680-7
references.pmid: 23124034
references.citation: J Am Coll Cardiol. 2011 Jul 26;58(5):493-501
references.pmid: 21777747
references.citation: J Am Coll Cardiol. 2008 Jun 3;51(22):2153-60
references.pmid: 18510963
references.citation: J Cardiovasc Electrophysiol. 2011 May;22(5):548-53
references.pmid: 21087329
references.citation: Am Heart J. 2012 Oct;164(4):616-24
references.pmid: 23067922
references.citation: J Am Coll Cardiol. 2010 Feb 23;55(8):725-31
references.pmid: 20170808
references.citation: J Am Coll Cardiol. 2013 Feb 19;61(7):741-8
references.pmid: 23410544
references.citation: Am J Cardiol. 1993 Nov 15;72(15):1137-41
references.pmid: 8237802
references.citation: Circulation. 2000 Mar 14;101(10):1145-51
references.pmid: 10715261
references.citation: Chest. 2004 Aug;126(2):476-86
references.pmid: 15302734
references.citation: Circulation. 1998 Sep 8;98(10):953-60
references.pmid: 9737514
references.citation: J Interv Card Electrophysiol. 1998 Jun;2(2):121-35
references.pmid: 9870004
references.citation: N Engl J Med. 2011 Dec 15;365(24):2268-76
references.pmid: 22082198
references.citation: Circ Arrhythm Electrophysiol. 2011 Dec;4(6):808-14
references.pmid: 21946315
references.citation: Circ Arrhythm Electrophysiol. 2010 Feb;3(1):32-8
references.pmid: 19995881
references.citation: Int J Cardiol. 2007 May 16;118(1):21-7
references.pmid: 17055081
references.citation: Heart. 2004 Mar;90(3):286-92
references.pmid: 14966048
references.citation: J Am Coll Cardiol. 2013 Feb 26;61(8):852-60
references.pmid: 23333141
references.citation: Am J Cardiol. 2007 May 1;99(9):1258-62
references.pmid: 17478154
references.citation: JAMA. 2002 Dec 25;288(24):3115-23
references.pmid: 12495391
references.citation: Eur J Heart Fail. 2010 Jun;12(6):623-9
references.pmid: 20498271
references.citation: Circ Arrhythm Electrophysiol. 2008 Aug;1(3):184-92
references.pmid: 19808412
references.citation: N Engl J Med. 2002 Dec 5;347(23):1834-40
references.pmid: 12466507
references.citation: J Cardiovasc Med (Hagerstown). 2007 Mar;8(3):138-43
references.pmid: 17312430
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Am J Cardiol. 2013 May 1;111(9):1311-4
references.pmid: 23465099
references.citation: Value Health. 2012 Mar-Apr;15(2):240-8
references.pmid: 22433754
references.citation: Can J Cardiol. 2012 Mar-Apr;28(2):125-36
references.pmid: 22433576
references.citation: J Cardiovasc Electrophysiol. 2004 May;15(5):507-12
references.pmid: 15149416
references.citation: Circulation. 1997 Oct 21;96(8):2617-24
references.pmid: 9355902
references.citation: Stroke. 1991 Aug;22(8):983-8
references.pmid: 1866765
references.citation: Crit Pathw Cardiol. 2011 Jun;10(2):76-83
references.pmid: 21988947
references.citation: Am Heart J. 2012 May;163(5):887-93
references.pmid: 22607868
references.citation: Eur Heart J. 2013 May;34(20):1481-8
references.pmid: 23186806
references.citation: Can J Cardiol. 2013 Oct;29(10):1241-8
references.pmid: 23313007
references.citation: Heart. 1998 Jun;79(6):543-7
references.pmid: 10078079
references.citation: Am J Cardiol. 2013 Jan 15;111(2):225-30
references.pmid: 23111138
references.citation: Eur J Intern Med. 2011 Oct;22(5):448-55
references.pmid: 21925051
references.citation: Arch Intern Med. 2012 Jul 9;172(13):997-1004
references.pmid: 22664954
references.citation: N Engl J Med. 1999 Sep 16;341(12):857-65
references.pmid: 10486417
references.citation: Pacing Clin Electrophysiol. 1995 Sep;18(9 Pt 1):1609-14
references.pmid: 7491304
references.citation: Am J Cardiol. 2009 Jan 15;103(2):248-54
references.pmid: 19121446
references.citation: Circulation. 1995 Oct 1;92(7):1954-68
references.pmid: 7671380