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Deactivation of Implantable Cardioverter Defibrillator Extravasation of IV Amiodarone Anticoagulation for AF, DVT and PE Patients Returning from Interventional Cardiac Procedure Cardiology Referrals STEMI Thrombolysis Protocol STEMI Hypertensive Emergencies Rate Control in AF Heart Failure Aortic Dissection Non ST Elevation MI (NSTEMI) Suspected Acute Coronary Syndrome Pericardiocentesis Pacemakers Indications for Echocardiography Bradycardia Narrow Complex Tachycardia Anti-Platelet Therapy in Coronary Heart Disease Management of Acute AF Rhythm Control in AF Atrial Fibrillation Hypertension Ventricular Tachycardia Cardiogenic Shock Complicating Acute Coronary Syndrome Telemetry

Home | Articles | Cardiac | Rate Control in AF

Rate Control in AF

Last updated 3rd December 2020

Goals and Therapies

There is currently no evidence that rhythm control is superior to rate control in preventing stroke or reducing mortality, therefore offer rate control as first line strategy for AF except when rhythm control would be more suitable on basis of clinical judgment
Generally suggested goals are ventricular rate 60-80 bpm at rest and <115 bpm with exercise, though a recent study of lenient versus strict rate control showed that patients randomised to resting heart rate of <110/min were no more symptomatic than those whose target resting heart rate was <80/min.
Offer either a standard beta-blocker (that is, a beta-blocker other than sotalol) or a rate-lowering calcium-channel blocker as initial monotherapy to people with AF who need drug treatment as part of a rate control strategy.
Base the choice of drug on the person’s symptoms, heart rate, comorbidities and preferences when considering drug treatment.
Do not give rate-lowering calcium-channel blockers in the presence of heart failure with low ejection fraction owing to their negative inotropic effect.
Consider digoxin monotherapy for non-paroxysmal AF only if patient does no or very little physical exercise.
If monotherapy does not control symptoms, and if continuing symptoms are thought to be due to poor ventricular rate control, consider combination therapy with any 2 of the following:
- a beta-blocker
- diltiazem
- digoxin
Combination of beta blocker and verapamil best avoided because of adverse effects on heart rate, blood pressure and LV function.
Amiodarone considered too toxic for long-term rate control but may be used for rate control in acute AF, especially in ICU.

Rate Control Strategies for AF

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