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Rate Control Medication for Atrial Fibrillation

Rate control medication slows the heart rate to generally less than 100 beats per minute by blocking some of the errant electrical signals in the atria and preventing them from being transmitted to the ventricles.

There have been ongoing discussions in the medical community as to which of two medication approaches—rate control or rhythm control—is best for atrial fibrillation patients. Some studies have suggested that rate control, when combined with anticoagulation, is as good as rhythm control, and may be better because rate control medications are considered safer and are good overall for treating heart disease and coronary disease.

Using rate control medication avoids subjecting patients to the riskier rhythm control medications. These studies indicate that unless rate control has not worked, it is less important to aggressively drive patients into a normal sinus rhythm. In either case, a decision as to whether to use anticoagulant medication is considered critical.1

Types of Rate Control Drugs

There are three types of rate control medications:

  1. Beta Blockers, which slow the heart rate and relax the blood vessels. Examples include Atenolol (Tenormin®), Carvedilol (Coreg™), Metoprolol (Toprol XL™, Lopressor®), and Sotalol (Betapace®)
  2. Calcium Channel Blockers, which relax blood vessels and reduce heart workload. Examples includes Diltiazem (Cardizem®, Tiazac®) and Verapamil (Calan®, Covera-HS®, Isoptin®)
  3. Cardiac Glycosides, which improve cardiac output, but can also be toxic. Digoxin (Lanoxin®) is an example of a cardiac glycoside.

Rate control medications, though less risky than rhythm control, aren't without risks, including:

  • Side effects, such as fatigue, shortness of breath, dizziness, and much worse
  • Can provoke cardiac arrhythmias — called proarrhythmic
  • Some can be toxic, such as cardiac glycosides

Rate control medications don't cure atrial fibrillation, so this medication regimen becomes life-long and may allow atrial enlargement, a condition where the atria enlarge due to being overworked. Recent research has shown that this increases the risk of stroke as well. To learn more, see Stuck in the Middle: Afib Patients on Rate Control.

If rate control medication proves unsuccessful for you, then rhythm control medication may restore your heart's normal sinus rhythm. Or your doctor may recommend a catheter ablation or surgical ablation. For more information about these procedures, see Can Afib Be Cured?

1 Wyse, D. George, M.D., "Rate Versus Rhythm Control in the Management of Atrial Fibrillation", American Heart Association, Copyright, 2006.

Last Modified 07/03/2012

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