Pharmacological rate control of atrial fibrillation
Abstract
To control ventricular rate in patients with AF, physicians should seek to control heart rate at rest and with exertion. The goal has to be achieved while minimizing costs and adverse effects. For emergency use, i.v. diltiazem or esmolol are drugs useful because of their rapid onset of action. They have to be used with caution in patients with concomitant left ventricular failure symptoms, however. For most patients with AF, chronic control of the ventricular rate can be achieved with one drug. For the chronic control of ventricular rate in patients with AF and normal ventricular function, diltiazem, atenolol, are metoprolol are probably the drugs of choice. For patients with AF and structurally abnormal hearts, atenolol, metoprolol, or carvedilol are appropriate choices. Adequate ventricular rate control by pharmacological agents should be evaluated by either 24-hour Holter monitoring or a submaximal stress test to determine the resting and exercise ventricular rate. If the mean ventricular rate is not close to 80 beats per minute, or the heart rate on moderate exertion is not between 90 to 115 beats per minute, a second agent to control the rate should be added. Excessive reductions in ventricular rates that could limit exercise tolerance should be avoided.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Compared with stroke prevention and rhythm control, very little robust evidence exists to inform the best type and intensity of rate control treatment, with the majority of data derived from short-term crossover trials and observational studies.
“Compared with stroke prevention and rhythm control, very little robust evidence exists to inform the best type and intensity of rate control treatment, with the majority of data derived from short-term crossover trials and observational studies.41,[526][527][528]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [527]
Cites
Goodman & Gilman's The Pharmacological Basis of Therapeutics
Brunton, L. L. (1985) · Cited by 7,321 · see citing works
Goodman and Gilman's the Pharmacological Basis of Therapeutics
Stigelman, W. H., & Pharm, D. (1986) · Military Medicine · doi:10.1093/milmed/151.1.386 · Cited by 6,796 · see citing works
A comparison of rate control and rhythm control in patients with atrial fibrillation
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa021328 · Cited by 4,405 · see citing works
Gelder, I. C. V., Hagens, V. E., Bosker, H. A., Kingma, J. H., Otto Kamp, B., Kingma, T., Said, S. A., Darmanata, J. I., Timmermans, A. J. M., Tijssen, J. G. P., et al. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa021375 · Cited by 2,355 · see citing works
Hohnloser, S. H., Kück, K., & Lilienthal, J. (2000) · The Lancet · doi:10.1016/s0140-6736(00)03230-x · Cited by 1,132 · see citing works
Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy
Maisel, W. H., & Stevenson, L. W. (2003) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)03373-8 · Cited by 967 · see citing works
Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation
CARLSSON, J., Miketíc, S., Windeler, J., Cuneo, A., Haun, S., Micus, S., Walter, S., & Tebbe, U. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00332-2 · Cited by 938 · see citing works
Grogan, M. A., Smith, H. C., Gersh, B. J., & Wood, D. L. (1992) · The American Journal of Cardiology · doi:10.1016/0002-9149(92)90705-4 · Cited by 519 · see citing works
DEEDWANIA, P. C., Singh, B. N., Ellenbogen, K. A., Fisher, S. G., Fletcher, R. D., & Singh, S. N. (1998) · Circulation · doi:10.1161/01.cir.98.23.2574 · Cited by 505 · see citing works
Farshi, R., Kistner, D., Sarma, J. S. M., Longmate, J. A., & Singh, B. N. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(98)00561-0 · Cited by 363 · see citing works
Digoxin for Converting Recent-Onset Atrial Fibrillation to Sinus Rhythm
Falk, R. H., Knowlton, A. A., Bernard, S. A., Gotlieb, N. E., & Battinelli, N. J. (1987) · Annals of Internal Medicine · doi:10.7326/0003-4819-106-4-503 · Cited by 335 · see citing works
SUTTORP, M. J., Kingma, J. H., JESSURUN, E. R., Lie‐A‐Huen, L., van Hemel, N. M., & Lie, K. I. (1990) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(90)90326-k · Cited by 282 · see citing works
Tachycardiomyopathy: Mechanisms and Clinical Implications
Fenelon, G., Wijns, W. C., Andries, E., & Brugada, P. (1996) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1996.tb04796.x · Cited by 233 · see citing works
Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter
Platia, E. V., Michelson, E. L., Porterfield, J. K., & Das, G. (1989) · The American Journal of Cardiology · doi:10.1016/0002-9149(89)90141-0 · Cited by 213 · see citing works
Prevalence and significance of atrial fibrillation in coronary artery disease (CASS registry)
Cameron, A., Schwartz, M. J., Kronmal, R. A., & Kosinski, A. S. (1988) · The American Journal of Cardiology · doi:10.1016/0002-9149(88)91053-3 · Cited by 201 · see citing works
What is meant by a "controlled" ventricular rate in atrial fibrillation?
Rawles, J. M. (1990) · Heart · doi:10.1136/hrt.63.3.157 · Cited by 165 · see citing works
Ellenbogen, K. A., Dias, V. C., Plumb, V. J., Heywood, J. T., & Mirvis, D. M. (1991) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(91)90743-s · Cited by 160 · see citing works
Peters, K. G., & Kienzle, M. G. (1988) · The American Journal of Medicine · doi:10.1016/s0002-9343(88)80352-8 · Cited by 160 · see citing works
Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter
Salerno, D. M., Dias, V. C., Kleiger, R. E., Tschida, V. H., Sung, R. J., Sami, M., & Giorgi, L. V. (1989) · The American Journal of Cardiology · doi:10.1016/0002-9149(89)90076-3 · Cited by 152 · see citing works
The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group (1997) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a015311 · Cited by 150 · see citing works
Jordaens, L. J. L. M., Trouerbach, J., Calle, P., Tavernier, R., Derycke, E., Vertongen, P., Bergez, B. M., & Vandekerckhove, Y. R. (1997) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a015310 · Cited by 145 · see citing works
Systematic review of the management of atrial fibrillation in patients with heart failure
Khand, A. U. (2000) · European Heart Journal · doi:10.1053/euhj.1999.1767 · Cited by 144 · see citing works
The evidence regarding the drugs used for ventricular rate control.
Segal, J. B., McNamara, R. L., Miller, M. R., Kim, N., Goodman, S. N., Powe, N. R., Robinson, K. A., Yu, D. S. F., & Bass, E. B. (2000) · PubMed · Cited by 139 · see citing works
Self-citationLundström, T., & Rydén, L. (1990) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(90)90461-w · Cited by 117 · see citing works
Schreck, D. M., Rivera, A. R., & Tricarico, V. J. (1997) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(97)70319-6 · Cited by 113 · see citing works
Hamer, M. E., Blumenthal, J. A., McCarthy, E. A., Phillips, B., & Pritchett, E. L. C. (1994) · The American Journal of Cardiology · doi:10.1016/0002-9149(94)90448-0 · Cited by 106 · see citing works
Goldenberg, I. F., Lewis, W. R., Dias, V. C., Heywood, J. T., & Pedersen, W. R. (1994) · The American Journal of Cardiology · doi:10.1016/0002-9149(94)90580-0 · Cited by 99 · see citing works
DiBianco, R., Morganroth, J., Freitag, J. A., et al. (1984) · American Heart Journal · doi:10.1016/0002-8703(84)90592-1 · Cited by 98 · see citing works
Lewis, R. V., McMurray, J. J. V., & McDevitt, D. (1989) · Journal of Cardiovascular Pharmacology · doi:10.1097/00005344-198901000-00002 · Cited by 95 · see citing works
Atwood, J. E., Sullivan, M. J., Forbes, S., MYERS, J. N., Pewen, W. F., Olson, H. G., & Froelicher, V. F. (1987) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(87)80013-x · Cited by 91 · see citing works
Kingma, J. H., & SUTTORP, M. J. (1992) · The American Journal of Cardiology · doi:10.1016/0002-9149(92)91079-j · Cited by 87 · see citing works
Verapamil improves exercise capacity in chronic atrial fibrillation: Double-blind crossover study
Lang, R. M., Klein, H. O., Segni, E. D., et al. (1983) · American Heart Journal · doi:10.1016/0002-8703(83)90246-6 · Cited by 78 · see citing works
Lewis, R. V., IRVINE, N., & McDevitt, D. G. (1988) · European Heart Journal · doi:10.1093/eurheartj/9.7.777 · Cited by 69 · see citing works
Levy, T., Walker, S., Mason, M., Spurrell, P., Rex, S., Brant, S., & Paul, V. (2001) · Heart · doi:10.1136/heart.85.2.171 · Cited by 67 · see citing works
Rate issues in atrial fibrillation: consequences of tachycardia and therapy for rate control
Schumacher, B. M., & Lüderitz, B. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00737-1 · Cited by 64 · see citing works
Koh, K. K., Kwon, K. S., Park, H. B., Baik, S. H., Park, S. J., Lee, K. H., Kim, E. J., Kim, S. H., Cho, S. K., & Kim, S. S. (1995) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)80538-4 · Cited by 61 · see citing works
Diltiazem and Exercise Performance in Patients with Chronic Atrial Fibrillation
Atwood, J. E., MYERS, J. N., Sullivan, M. J., et al. (1988) · CHEST Journal · doi:10.1378/chest.93.1.20 · Cited by 58 · see citing works
A comparison of digoxin, diltiazem and their combination in the treatment of atrial fibrillation
Lewis, R. V., Laing, E., Moreland, T. A., Service, E. G., & McDevitt, D. (1988) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a062497 · Cited by 56 · see citing works
Atrioventricular Node Reentry: Physiology and Radiofrequency Ablation
Prystowsky, E. N. (1997) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1997.tb06210.x · Cited by 56 · see citing works
Resnekov, L., & McDonald, L. (1971) · Heart · doi:10.1136/hrt.33.3.339 · Cited by 51 · see citing works
Matsuda, M., Matsuda, Y., Yamagishi, T., Takahashi, T., Haraguchi, M., Tada, T., & Kusukawa, R. (1991) · Cardiovascular Research · doi:10.1093/cvr/25.6.453 · Cited by 50 · see citing works
Lee, S. H., Chen, S. A., Chiang, C., TAI, C. T., Wen, Z., Wang, S. P., & Chang, M.-S. (1996) · Journal of Internal Medicine · doi:10.1046/j.1365-2796.1996.451805000.x · Cited by 48 · see citing works
Wong, C., White, H. D., Wilcox, R. G., et al. (2002) · Heart · doi:10.1136/heart.88.4.357 · Cited by 48 · see citing works
Tse, H., Lam, Y., Lau, C., Cheung, B. M. Y., & Kumana, C. R. (2001) · Clinical and Experimental Pharmacology and Physiology · doi:10.1046/j.1440-1681.2001.03454.x · Cited by 47 · see citing works
Koh, K. K., Song, J. H., Kwon, K. S., et al. (1995) · International Journal of Cardiology · doi:10.1016/0167-5273(95)02480-k · Cited by 46 · see citing works
Panidis, I. P., Morganroth, J., & Baessler, C. (1983) · The American Journal of Cardiology · doi:10.1016/0002-9149(83)90573-8 · Cited by 46 · see citing works
Placebo controlled trial of xamoterol versus digoxin in chronic atrial fibrillation.
Ang, E. L., Chan, W. L., Cleland, J. G. F., et al. (1990) · Heart · doi:10.1136/hrt.64.4.256 · Cited by 39 · see citing works
A comparison of verapamil and digoxin in the treatment of atrial fibrillation
LEWIS, R., LAKHANI, M., Moreland, T. A., et al. (1987) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a062242 · Cited by 38 · see citing works
for the DAAF Trial Group, Hornestam, B., Jerling, M., et al. (2003) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-002-0553-3 · Cited by 35 · see citing works
Perceived exertion and gas exchange after calcium and beta-blockade in atrial fibrillation
Myers, J., Atwood, J. E., Sullivan, M. J., et al. (1987) · Journal of Applied Physiology · doi:10.1152/jappl.1987.63.1.97 · Cited by 34 · see citing works
Rate Control and Sinus Rhythm Maintenance in Atrial Fibrillation
Stafford, R. S., Robson, D. C., Misra, B., Ruskin, J. N., & Singer, D. E. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.19.2144 · Cited by 32 · see citing works
Usefulness of labetalol in chronic atrial fibrillation
Wong, C., Lau, C., Leung, W., & Cheng, C. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)91102-c · Cited by 31 · see citing works
Brodsky, M. A., Saini, R. K., Bellinger, R. L., Zoble, R. G., Weiss, R., & Powers, L. (1994) · American Heart Journal · doi:10.1016/0002-8703(94)90665-3 · Cited by 31 · see citing works
Clinical Use of Oral Verapamil in Chronic and Paroxysmal Atrial Fibrillation
Stern, E. H., Pitchon, R., King, B. D., Guerrero, J., Schneider, R. R., & Wiener, I. (1982) · CHEST Journal · doi:10.1378/chest.81.3.308 · Cited by 28 · see citing works
Pomfret, S. M., Beasley, R. W., Challenor, V., et al. (1988) · Clinical Science · doi:10.1042/cs0740351 · Cited by 28 · see citing works
Antiarrhythmic effects of intravenous timolol in supraventricular arrhythmias
Sweany, A. E., Moncloa, F., Vickers, F. F., & Zupkis, R. V. (1985) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.1985.23 · Cited by 27 · see citing works
Rc, A., Sinha, N., Saran, R. K., et al. (1989) · International Journal of Cardiology · doi:10.1016/0167-5273(89)90223-4 · Cited by 25 · see citing works
Channer, K. S., James, M., MacConnell, T., et al. (1994) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1994.tb04238.x · Cited by 24 · see citing works
Zoble, R. G., Brewington, J., Olukotun, A. Y., & Gore, R. (1987) · The American Journal of Cardiology · doi:10.1016/0002-9149(87)90707-7 · Cited by 24 · see citing works
Agarwal, A. K., & Venugopalan, P. (2001) · European Journal of Heart Failure · doi:10.1016/s1388-9842(01)00130-1 · Cited by 22 · see citing works
Lok, N.-S., & Lau, C. (1997) · CHEST Journal · doi:10.1378/chest.111.4.934 · Cited by 21 · see citing works
The effect of atrial fibrillation and the ventricular rate control on exercise capacity
Ostermaier, R., Vecchia, L. A. D., Lampert, S., et al. (1997) · Clinical Cardiology · doi:10.1002/clc.4960200107 · Cited by 19 · see citing works
Lundström, T., Moor, E., & Rydén, L. (1992) · American Heart Journal · doi:10.1016/0002-8703(92)90973-y · Cited by 17 · see citing works
Xamoterol improves the Control of Chronic Atrial Fibrillation in Elderly Patients
Lawson-Matthew, P. J., McLean, K. A., Dent, M., et al. (1995) · Age and Ageing · doi:10.1093/ageing/24.4.321 · Cited by 17 · see citing works
Kochiadakis, G. E. (2001) · EP Europace · doi:10.1053/eupc.2000.0140 · Cited by 17 · see citing works
Effects of diltiazem, propranolol, and their combination in the control of atrial fibrillation
Dahlström, C. M., Olsson, S. B., Edvardsson, N. G., et al. (1992) · Clinical Cardiology · doi:10.1002/clc.4960150411 · Cited by 13 · see citing works
Ahuja, R. C., Sinha, N., Kumar, R., & Saran, R. K. (1993) · International Journal of Cardiology · doi:10.1016/0167-5273(93)90115-w · Cited by 10 · see citing works
Pintér, A., Dorian, P., Paquette, M., et al. (2003) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/107424840300800i104 · Cited by 10 · see citing works
Effect of Orally Administered Celiprolol in Patients with Chronic Atrial Fibrillation
Lin, S. K., Morganroth, J., Heng, M., et al. (1986) · Journal of Cardiovascular Pharmacology · doi:10.1097/00005344-198608004-00025 · Cited by 8 · see citing works
Tamariz, L. J., McNamara, R. L., & Bass, E. B. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)82867-x · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805 · see citing works
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000040 · Cited by 2,056 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Le Huezey, J.-Y., Lowe, J. E., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318214876d · Cited by 859 · see citing works
Ulimoen, S. R., Enger, S., Carlson, J., Platonov, P. G., Pripp, A. H., Abdelnoor, M., Arnesen, H., Gjesdal, K., & Tveit, A. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.09.020 · Cited by 113 · see citing works
- Authors
- Tamariz, L. J., & Bass, E. B.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Tamariz, Leonardo J
- Venue
- Cardiology Clinics
- Publisher
- Elsevier BV
- Published
- 2004-02
- Volume
- 22
- Issue
- 1
- Pages
- 35-45
- ISSN
- 0733-8651 (ISSN-L)
- OpenAlex
- W2003014483
- Cited by
- 53
- References
- 70
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 3 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 1 · 2012: 5
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiology Clinics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5t32hl007180-45)
- National Heart, Lung, and Blood Institute (T32 HL07180)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, rate control, ventricular rate, diltiazem, esmolol, atenolol, metoprolol, carvedilol, beta-blockers, left ventricular failure, heart rate response to exercise, Holter monitoring, adverse drug reactions
- MeSH terms
- Amiodarone, Atenolol, Atrial Fibrillation, Cardiotonic Agents, Digoxin, Diltiazem, Heart Rate, Humans, Metoprolol, Verapamil, Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
