{ "schemaVersion": 2, "eyebrow": "Heart Failure", "title": "Atrial Fibrillation Rate Control", "summary": "For atrial fibrillation with heart failure, select rate-control therapy by hemodynamic status, ventricular function, activity-related tachycardia, and drug tolerance; a resting rate below 110 beats/min is generally a practical initial target in stable permanent AF.", "seoDescription": "Clinical approach to atrial fibrillation rate control in heart failure, including heart-rate targets, drug selection, digoxin limitations, and escalation.", "clinicalQuestion": "How should ventricular rate be controlled in adults with atrial fibrillation and concomitant heart failure?", "specialty": "Cardiology", "audience": "U.S. physicians and medical trainees", "tags": [ "atrial fibrillation", "heart failure", "rate control", "beta-blocker", "digoxin", "AV node ablation" ], "keyTakeaways": [ "In stable permanent AF with moderate heart failure, lenient control targeting resting heart rate below 110 beats/min was as effective as strict control and was easier to achieve. [10]", "Beta-blockers reduce ventricular rate and are generally preferable to long-term amiodarone for persistent AF with LV systolic dysfunction because beta-blockers improve heart-failure prognosis. [13]", "Digoxin lowers resting ventricular rate but not exercise rate; use it principally as adjunctive therapy or when alternatives are ineffective or contraindicated. [1][23]", "Avoid non-dihydropyridine calcium-channel blockers as routine rate-control drugs in heart failure; diltiazem safety is a specific concern in this population. [13][23]", "For refractory rate control, consider AF catheter ablation before AV-node ablation with pacemaker implantation; AV-node ablation is otherwise a last-resort rate-control strategy. [23]" ], "sections": [ { "id": "initial-rate-control-decision", "eyebrow": "First decision", "heading": "Set a practical heart-rate target and identify patients needing a rhythm-control pathway", "intro": "Use rate control as an immediate management objective while reassessing whether AF is worsening heart failure.", "paragraphs": [ "For stable permanent AF with heart failure, use a resting ventricular rate below 110 beats/min as a practical initial target. In the heart-failure subgroup of RACE II, lenient control defined by resting heart rate below 110 beats/min was as effective as strict control defined by resting heart rate below 80 beats/min plus a rate below 110 beats/min during moderate exercise; target attainment was higher with lenient control (94.6% versus 73.8%). [10]", "Do not intensify rate-slowing therapy solely to reach a resting rate below 80 beats/min when the patient is clinically stable at a rate below 110 beats/min. Lenient control was not independently associated with adverse left-atrial or left-ventricular remodeling in permanent AF, and strict targets required more treatment visits. [9][10]", "Escalate beyond a rate-control-only strategy when AF appears to be driving heart-failure morbidity despite pharmacologic rate control. AF and heart failure amplify one another clinically, and catheter ablation has been tested specifically in patients with AF and heart failure; evaluate candidacy for AF ablation before committing a refractory patient to AV-node ablation and permanent pacing. [7][8][23]" ], "bullets": [ "Document resting ventricular rate after medication adjustment; use the less burdensome lenient target first in clinically stable permanent AF with moderate heart failure. [10]", "Assess exertional symptoms and activity-related tachycardia before accepting adequate control based only on a resting measurement, because digoxin does not lower exercise heart rate. [1]", "Treat a persistently rapid ventricular response despite tolerated therapy as a trigger to reconsider rhythm control or procedural rate control rather than indefinitely layering AV-nodal drugs. [23]" ], "subsections": [], "table": { "caption": "Rate-control targets studied in permanent AF with moderate heart failure. [10]", "columns": [ "Strategy", "Heart-rate target", "Practical implication" ], "rows": [ [ "Lenient rate control", "Resting heart rate <110 beats/min. [10]", "Initial target for clinically stable permanent AF; achieved in 94.6% during dose adjustment. [10]" ], [ "Strict rate control", "Resting heart rate <80 beats/min and <110 beats/min during moderate exercise. [10]", "More difficult to achieve; reserve tighter control for a patient-specific symptom or ventricular-function rationale. [10]" ] ] } }, { "id": "drug-selection-by-heart-failure-phenotype", "eyebrow": "Drug selection", "heading": "Choose AV-nodal therapy by systolic function, blood pressure, activity, and prior treatment response", "intro": "Prioritize therapies that control rate without compromising the heart-failure treatment plan.", "paragraphs": [ "In AF with LV systolic dysfunction, use a beta-blocker as the preferred pharmacologic foundation for ventricular rate control when tolerated. Beta-blockers reduce ventricular rate in AF and have established prognostic benefit in heart failure with LV systolic dysfunction; in AF plus heart failure, available trials suggest beta-blockers reduce ventricular rate, improve ventricular function, and are tolerated. [13][14]", "Avoid treating digoxin monotherapy as adequate control in an ambulatory, physically active patient. Digoxin reduced resting heart rate in chronic AF but did not reduce heart rate during exercise. When inadequate resting or exertional control persists on tolerated beta-blockade, digoxin can be added for AV-nodal synergy; combined atenolol plus digoxin produced lower 24-hour and exercise ventricular rates than digoxin, diltiazem, or digoxin plus diltiazem in a crossover study. [1][14]", "Avoid non-dihydropyridine calcium-channel blockers as the routine alternative in heart failure. Reviews identify beta-blockers and digoxin as rate-control options in heart failure, while non-dihydropyridine calcium-channel blockers are described as effective rate-control agents outside heart failure; concerns specifically exist regarding diltiazem safety in heart failure. [13][23]", "Reserve chronic amiodarone-based rate control for situations in which preferred AV-nodal strategies are not usable or have failed and a rhythm-control effect is acceptable. Amiodarone reduced ventricular rate and was associated with more spontaneous cardioversion than placebo in a heart-failure subgroup analysis, but long-term toxicities and the prognostic advantage of beta-blockers favor beta-blockers for persistent AF with LV systolic dysfunction. [13]" ], "bullets": [ "Use a beta-blocker first when LV systolic dysfunction and hemodynamics permit. [13]", "Add digoxin when beta-blocker therapy does not provide adequate rate control or cannot be sufficiently titrated, particularly when heart failure limits alternatives. [23]", "Do not use digoxin to convert recent-onset AF to sinus rhythm; randomized trials found conversion no more likely or faster than with placebo. [1]", "Avoid assuming that a controlled clinic resting rate reflects exertional control in a patient receiving digoxin. [1]" ], "subsections": [], "table": { "caption": "Medication-selection tradeoffs for rate control in AF with heart failure. [1][13][14][23]", "columns": [ "Option", "Best-supported role", "Limitation that changes management" ], "rows": [ [ "Beta-blocker", "Preferred pharmacologic rate-control foundation in AF with LV systolic dysfunction when tolerated. [13]", "AV-nodal slowing can limit use when bradycardia or hypotension develops; combination therapy further increases bradycardia risk. [3]" ], [ "Digoxin", "Adjunct to beta-blocker or option when other therapies are ineffective or contraindicated, especially with heart failure. [23]", "Reduces resting but not exercise heart rate; not effective for AF conversion. [1]" ], [ "Diltiazem or verapamil", "Effective AV-nodal agents in AF outside heart failure. [23]", "Do not use routinely in heart failure; diltiazem safety is a concern. [13][23]" ], [ "Amiodarone", "Alternative when standard rate-control options are unsuitable; may lower rate and facilitate spontaneous cardioversion. [13]", "Long-term adverse effects make it less desirable than beta-blockers for persistent AF with LV systolic dysfunction. [13]" ] ] } }, { "id": "digoxin-safety-and-monitoring", "eyebrow": "Digoxin", "heading": "Use digoxin cautiously when heart failure narrows rate-control options", "intro": "The major clinical limitations are inadequate exertional control, bradyarrhythmia with combination therapy, and disease-specific susceptibility.", "paragraphs": [ "Avoid digoxin when the heart-failure phenotype includes restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease, acute cor pulmonale, or idiopathic hypertrophic subaortic stenosis unless ventricular rate control in AF is judged necessary and alternatives are unsuitable. Digoxin can reduce cardiac output in several preserved-ejection-fraction conditions, can worsen outflow obstruction in hypertrophic subaortic stenosis, and amyloid heart disease increases susceptibility to toxicity even at therapeutic concentrations. [1]", "When combining digoxin with a beta-blocker, monitor for excessive AV-nodal suppression and bradycardia. Both drug classes slow AV conduction and heart rate; concomitant administration increases bradycardia risk. Sotalol labeling also reports more proarrhythmic events among sotalol-treated patients receiving digoxin, although whether this is causal or reflects concomitant heart failure is uncertain. [3]", "Counseling and follow-up should focus on toxicity-related rhythm disturbance rather than assuming a therapeutic response from resting pulse alone. Digoxin toxicity commonly manifests with dysrhythmias, and its limited exercise rate control means persistent exertional palpitations or dyspnea should prompt reassessment of the rate-control regimen rather than automatic dose escalation. [1][24]" ], "bullets": [ "Avoid digoxin as a default choice in cardiac amyloidosis because toxicity may occur at therapeutic levels. [1]", "Reassess the full AV-nodal drug regimen when bradycardia occurs after adding digoxin to beta-blocker therapy. [3]", "Do not use digoxin for pharmacologic cardioversion of recent-onset AF. [1]" ], "subsections": [], "table": { "caption": "Digoxin-specific decision points in AF with heart failure. [1][3][23][24]", "columns": [ "Clinical finding", "Interpretation", "Next action" ], "rows": [ [ "Resting rate improves but exertional rate remains rapid", "Expected limitation of digoxin monotherapy. [1]", "Optimize or add a beta-blocker if tolerated; assess whether a rhythm-control strategy is more appropriate. [14][23]" ], [ "Bradycardia after adding digoxin to beta-blocker therapy", "Additive AV-nodal slowing. [3]", "Reassess the combination rather than escalating either agent. [3]" ], [ "Amyloid, restrictive, constrictive, acute cor pulmonale, or hypertrophic obstructive phenotype", "Higher risk of reduced output, toxicity, or worsened obstruction with digoxin. [1]", "Generally avoid digoxin; use only if rate-control necessity outweighs the phenotype-specific risk. [1]" ] ] } }, { "id": "refractory-rate-control", "eyebrow": "Escalation", "heading": "Escalate refractory ventricular rate control to ablation-based strategies", "intro": "Do not equate failure of one drug regimen with a need for indefinite multidrug AV-nodal suppression.", "paragraphs": [ "Consider catheter ablation of AF in heart-failure patients whose symptoms, recurrent decompensation, or ventricular dysfunction remain attributable to AF despite a reasonable rate-control attempt. Catheter ablation has been evaluated in patients with AF and heart failure, and expert synthesis recommends considering AF ablation before AV-node ablation for rate control. [7][23]", "Use AV-node ablation with pacemaker implantation as a definitive rate-control option when drug therapy has not produced acceptable control and AF ablation is not appropriate, has failed, or is declined. This approach is considered a last resort for rate control, but may be considered earlier in patients already managed with cardiac resynchronization therapy. [23]", "After AV-node ablation, the procedural tradeoff is permanent pacemaker dependence; therefore, define the goal before referral as durable ventricular-rate regularization rather than restoration of sinus rhythm. Patients receiving cardiac resynchronization therapy represent a distinct group in whom earlier AV-node ablation may be considered to support the pacing strategy. [23]" ], "bullets": [ "Refer for AF ablation assessment before AV-node ablation when AF remains clinically consequential in heart failure. [23]", "Consider AV-node ablation with pacing after intolerance or failure of pharmacologic rate control, particularly when a durable rate-control endpoint is needed. [23]", "In a patient with cardiac resynchronization therapy, discuss AV-node ablation earlier than in a patient without a pacing-based strategy. [23]" ], "subsections": [], "table": { "caption": "Procedural escalation for AF rate control in heart failure. [7][23]", "columns": [ "Procedure", "When to consider", "Key tradeoff" ], "rows": [ [ "Catheter ablation of AF", "AF remains clinically important in heart failure despite medical management; consider before AV-node ablation. [7][23]", "Targets AF itself and may support rhythm control rather than merely slowing ventricular response. [23]" ], [ "AV-node ablation plus pacemaker", "Refractory or intolerant pharmacologic rate control when AF ablation is not suitable, unsuccessful, or not desired. [23]", "Permanent pacing dependence; generally a last-resort rate-control intervention. [23]" ] ] } }, { "id": "avoid-common-management-errors", "eyebrow": "Pitfalls", "heading": "Avoid rate-control choices that worsen heart failure or leave exertional tachycardia untreated", "intro": "Most avoidable errors arise from applying a resting-rate measurement or a generic AF regimen without accounting for heart-failure phenotype.", "paragraphs": [ "Do not use sotalol as a simple rate-control substitute in a patient with substantial renal dysfunction, dialysis dependence, or obstructive lung disease; its labeling lists serious kidney problems or dialysis and pulmonary disease causing shortness of breath, including asthma, chronic bronchitis, and emphysema, among contraindication-related patient warnings. Sotalol also produces dose-related QTc prolongation and carries a proarrhythmic risk. [3]", "If dofetilide is being considered as part of a rhythm-control strategy rather than for routine rate control, treat QT prolongation and torsade de pointes risk as the central safety constraints. Dofetilide produces a dose-related QT increase, and clinical evaluation specifically assessed torsade de pointes frequency according to dose. [4]", "Do not add multiple AV-nodal agents without reassessing bradycardia, hypotension, and the clinical target. Sotalol plus digoxin can increase bradycardia risk, and sotalol combined with calcium-channel blockers can produce additive effects on AV conduction, ventricular function, and blood pressure. [3]" ], "bullets": [ "Avoid using digoxin for a goal it does not achieve: exercise-rate reduction or AF conversion. [1]", "Avoid routine diltiazem or verapamil use in heart failure when beta-blocker- and digoxin-based strategies are available. [13][23]", "Avoid escalating to stricter resting-rate targets without a patient-specific indication after achieving a resting rate below 110 beats/min. [9][10]" ], "subsections": [], "table": { "caption": "Common rate-control errors and corrective actions. [1][3][9][10][13][23]", "columns": [ "Error", "Why it matters", "Correction" ], "rows": [ [ "Escalating therapy solely to achieve resting heart rate <80 beats/min", "Strict control was harder to achieve and did not show superiority over lenient control in moderate heart failure. [10]", "Use <110 beats/min at rest as the initial stable-patient target. [10]" ], [ "Using digoxin alone in a symptomatic active patient", "Digoxin does not control exercise heart rate. [1]", "Use or optimize beta-blockade if tolerated; reassess for an ablation-based rhythm-control strategy when AF remains consequential. [14][23]" ], [ "Combining AV-nodal agents without monitoring tolerance", "Additive bradycardia, hypotension, and AV-conduction effects may occur. [3]", "Reassess drug combinations and reduce treatment intensity if bradycardia or hypotension emerges. [3]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "These highlights do not include all the information needed to use DIGOXIN TABLETS safely and effectively. See full prescribing information for DIGOXIN TABLETS. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "These highlights do not include all the information needed to use DIGOXIN TABLETS safely and effectively. See full prescribing information for DIGOXIN TABLETS. DIGOXIN tablets, for oral use Initial U.S. Approval: 1954", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=41c16cff-b03e-405e-a617-d6f45d3ce2bd&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "Patients with heart failure associated with preserved left ventricular ejection fraction may experience decreased cardiac output with use of Digoxin Tablets. Such disorders include restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease, and acute cor pulmonale. Patients with id", "score": 0.60666215 }, { "number": 2, "title": "highlights of prescribing information - DailyMed", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=dfac7f13-28be-423d-9389-9089da29da17&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "Digoxin has also been studied as a means of controlling the ventricular response to chronic atrial fibrillation in adults. Digoxin reduced the resting heart", "score": 0.5674818 }, { "number": 3, "title": "Sotalol Hydrochloride Tablets, USP (AF) 80 mg, 120 mg, and 160 mg", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2577dd8d-ab1b-4a55-990a-18c69395edfe", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "In man, the Class II (beta-blockade) electrophysiological effects of Sotalol AF are manifested by increased sinus cycle length (slowed heart rate), decreased AV nodal conduction and increased AV nodal refractoriness. The Class III electrophysiological effects in man include prolongation of the atria", "score": 0.51032627 }, { "number": 4, "title": "TIKOSYN ®\n (dofetilide) Capsules", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=b77b4388-36ec-4971-90a5-353879adb8b5", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "Figure 2: Relationship Between TIKOSYN Dose, QTc Increase and Maintenance of NSR\n \nfigure 2 \n Number of patients evaluated for maintenance of NSR: 503 TIKOSYN, 174 placebo. \n Number of patients evaluated for QTc change: 478 TIKOSYN, 167 placebo.\n\nfigure 2\n\n# CLINICAL STUDIES\n\n## Chronic Atr", "score": 0.46497503 }, { "number": 5, "title": "Lenient rate control versus strict rate control for atrial fibrillation: a protocol for the Danish Atrial Fibrillation (DanAF) randomised clinical trial", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/11/3/e044744.reviewer-comments", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "Title: Lenient rate control versus strict rate control for atrial fibrillation: a protocol for the Danish Atrial Fibrillation (DanAF) randomised clinical trial\n1) The authors compare the effect of lenient rate control and strict. ventricular rate' in heart failure patients, they should consider. len", "score": 0.709684 }, { "number": 6, "title": "Relationships among achieved heart rate, β-blocker dose ...", "detail": "openheart.bmj.com", "url": "https://openheart.bmj.com/content/3/2/e000520", "authors": "openheart.bmj.com", "host": "openheart.bmj.com", "snippet": "by RJH Miller · 2016 · Cited by 6 — β-blocker dose and lower heart rate are associated with decreased mortality in patients with systolic heart failure (HF) and sinus rhythm.", "score": 0.5749443 }, { "number": 7, "title": "Catheter Ablation for Atrial Fibrillation with Heart Failure", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1707855", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone.", "score": 0.7089592 }, { "number": 8, "title": "Rhythm Control versus Rate Control for Atrial Fibrillation and Heart ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa0708789", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Atrial fibrillation can lead to heart failure, and heart failure can lead to atrial fibrillation, which is present in 10 to 50% of patients", "score": 0.6929958 }, { "number": 9, "title": "Effect of Lenient Versus Strict Rate Control on Cardiac Remodeling in Patients With Atrial Fibrillation: Data of the RACE II (RAte Control Efficacy in permanent atrial fibrillation II) Study | JACC", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2011.04.030", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Title: Effect of Lenient Versus Strict Rate Control on Cardiac Remodeling in Patients With Atrial Fibrillation: Data of the RACE II (RAte Control Efficacy in permanent atrial fibrillation II) Study | JACC\n# Effect of Lenient Versus Strict Rate Control on Cardiac Remodeling in Patients With Atrial Fi", "score": 0.7382357 }, { "number": 10, "title": "Abstract 16829: Stringency of Rate Control in Patients with Atrial Fibrillation and Heart Failure: Data of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate Control II (RACE II) Study", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circ.122.suppl_21.A16829", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Abstract 16829: Stringency of Rate Control in Patients with Atrial Fibrillation and Heart Failure: Data of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate Control II (RACE II) Study | Circulation. Abstract 16829: Stringency of Rate Control ", "score": 0.7099254 }, { "number": 11, "title": "Ambulatory atrial fibrillation detection and quantification by wristworn AI device compared to standard holter monitoring | npj Digital Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41746-025-01555-9?fromPaywallRec=false", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "AF is a major risk factor for ischaemic stroke (IS). Approximately 25% of strokes are attributed to previously undetected asymptomatic AF. Timely detection could have prevented many of these strokes through the initiation of anticoagulation therapy2.\"),3.\"). However, as AF can be paroxysmal or compl", "score": 0.4808937 }, { "number": 12, "title": "Digoxin and Mortality in Patients With Atrial Fibrillation", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2017.12.060", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Digoxin, a well-established drug in cardiovascular medicine, is widely used in patients with atrial fibrillation (AF). Current guidelines (1,2) recommend digoxin for rate control in patients with AF, particularly those with concomitant heart failure. Digoxin has been evaluated in patients with heart", "score": 0.767847 }, { "number": 13, "title": "Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2003.07.020", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Beta-blockers have been shown to improve the prognosis of patients with HF and left ventricular (LV) systolic dysfunction, a substantial minority of whom had AF as their baseline rhythm (3–5). In patients without HF, beta-blockers improve ventricular rate control in AF when added to digoxin or when ", "score": 0.7420672 }, { "number": 14, "title": "Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/S0735-1097%2898%2900561-0", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "be more effective in reducing ventricular response in these patients (9–11,14–21)00561-0#BIB9). Beta-blockers are effective in reducing the VR in CAF at rest and during exercise (22)00561-0#BIB22). Verapamil and diltiazem, two calcium-channel blockers with potent negative dromotropic properties, hav", "score": 0.6947383 }, { "number": 15, "title": "Recent-onset atrial fibrillation: challenges and opportunities | European Heart Journal | Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartj/article/47/2/170/8236606", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "OpenURL Placeholder Text\n\nWorldCat\n\n170\n\nRillig\n\nA\n\n, \n\nMagnussen\n\nC\n\n, \n\nOzga\n\nAK\n\n, \n\nSuling\n\nA\n\n, \n\nBrandes\n\nA\n\n, \n\nBreithardt\n\nG\n\n, et al.\n\nEarly rhythm control therapy in patients with atrial fibrillation and heart failure\n\n.\n\nCirculation\n\n2021\n\n;\n\n144\n\n:\n\n845\n\n–\n\n58\n\n.\n\n10.1161/CIRCULATIONAHA.", "score": 0.491725 }, { "number": 16, "title": "Obesity and cardiovascular disease: mechanistic insights and ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurjpc/article/29/17/2218/6675714", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Potential effects of bariatric surgery on the incidence of heart failure and atrial fibrillation in patients with type 2 diabetes mellitus", "score": 0.12670976 }, { "number": 17, "title": "Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program) - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002914919314948", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program) - ScienceDirect\n# Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from ", "score": 0.8409005 }, { "number": 18, "title": "RAte Control Efficacy in permanent atrial fibrillation: a comparison between lenient versus strict rate control in patients with and without heart failure. Background, aims, and design of RACE II - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002870306001724", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### J Am Coll Cardiol\n\n### The relationship between achieved heart rate and outcomes in patients with atrial fibrillation: an analysis from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study\n\n### Am J Cardiol\n\n### A comparison of low versus high heart rate in patient", "score": 0.6755297 }, { "number": 19, "title": "Variation in heart rate range by 24‐h Holter monitoring predicts ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.14035", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Prognostic significance of resting heart rate and use of β-blockers in atrial fibrillation and sinus rhythm in patients with heart failure", "score": 0.6097339 }, { "number": 20, "title": "Clinical Use of Oral Verapamil in Chronic and Paroxysmal Atrial Fibrillation - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0012369215338277", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Prog Cardiovasc Dis\n\n### Digoxin: how effective for rate control in ambulatory patients with atrial fibrillation (abstract).\n\n### Circulation\n\n### Calcium channel blocking agents in the treatment of cardiovascular disorders. Part I: Basic and clinical electrophysiologic effects.\n\n### Ann Intern ", "score": 0.54274267 }, { "number": 21, "title": "2017 ISHNE‐HRS expert consensus statement on ambulatory ECG ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/anec.12447", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "A comparison of rate control and rhythm control in patients with atrial fibrillation. New England Journal of Medicine, 347, 1825–1833", "score": 0.49978086 }, { "number": 22, "title": "Effects of diltiazem, propranolol, and their combination in the control ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.4960150411", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "It is concluded that the combination of diltiazem and propranolol has no advantages over any of these drugs singly, in the moderation of heart rate in patients", "score": 0.45522344 }, { "number": 23, "title": "Beta-Blockers and Outcome in Heart Failure and Atrial Fibrillation: A Meta-Analysis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2213177912000054", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Review article Rate control in atrial fibrillation van Gelder I.C., …, Olshansky B.The Lancet • Volume 388 • 2016 Show 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", "score": 0.7522497 }, { "number": 24, "title": "Evidenced-Based Pharmacotherapy for Rate Control in Atrial...", "detail": "journals.lww.com", "url": "https://journals.lww.com/00002727-201304000-00014", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The most common adverse effect on patients taking digoxin is toxicity that induces dysrhythmias. Patients need to be taught how to take their apical pulse", "score": 0.61834323 } ], "publishedAt": "2026-09-15T21:52:31.784949+00:00", "updatedAt": "2026-09-15T21:52:31.784949+00:00", "readingMinutes": 6, "slug": "atrial-fibrillation-rate-control" }