title: Rate control in atrial fibrillation.
abstract: Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent. β blockers, alone or in combination with digoxin, or non-dihydropyridine calcium-channel blockers (not in heart failure) effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for physically inactive patients aged 80 years or older, in whom other treatments are ineffective or are contraindicated, and as an additional drug to other rate-controlling drugs, especially in heart failure when instituted cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues remain.
authors: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. Electronic address: i.c.van.gelder@umcg.nl.
authors: Isabelle C
authors: IC
authors: Van Gelder
authors: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Michiel
authors: M
authors: Rienstra
authors: Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands.
authors: Harry J G M
authors: HJ
authors: Crijns
authors: Mercy Heart and Vascular Institute, Mercy Medical Center North Iowa, Mason City, IA, USA.
authors: Brian
authors: B
authors: Olshansky
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D001919:Bradycardia / Q000628:therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D017115:Catheter Ablation; D004077:Digoxin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D010138:Pacemaker, Artificial; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013015:Sotalol / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D001262:Atenolol; D004077:Digoxin; D013015:Sotalol; D000638:Amiodarone