Rate Control Medication for Atrial Fibrillation

There is much debate about the best approach for managing atrial fibrillation: rate control or rhythm control? While rhythm control is designed to return the heart to its normal sinus rhythm and maintain that rhythm, rate control is designed to reduce the number of beats per minute to address one of the most bothersome symptoms of afib, a high heart rate.

The goal of rate control is to get your resting heart rate below 80 beats per minute, called strict rate control. However, a heart rate less than 110 beats per minute (lenient rate control) may be fine if your symptoms cease and your left ventricular systolic function, a sign of how well the left ventricle is pumping blood, remains normal.1

Studies have found that rate control improves the quality of life, reduces the risk of death related to afib, and reduces the possibility of developing cardiomyopathy, a thickening of the heart muscle that can lead to death.2

Some early studies, such as the AFFIRM Trial, suggested that rate control, when combined with anticoagulation, was equal to rhythm control in controlling afib. The studies even suggested that rate control might be superior given that the medications used were considered safer, with fewer side effects, than the antiarrhythmic drugs used for rhythm control.2,3,4

More recent studies have called these results into question and demonstrated the benefits of early rhythm control in managing afib.

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Types of Rate Control Medications

You and your doctor will decide what rate control medication(s) are best for you based on your symptoms, heart function, presence of heart failure or other medical conditions, and what afib triggers you might have.2

Beta blockers are the most commonly used medications, followed by calcium channel blockers and digoxin. Amiodarone or dronedarone may be used as they are antiarrhythmic drugs with beta-blocking properties.2  

Rate control medications don’t cure atrial fibrillation, so you may need to take them throughout your life. However, this may lead to atrial enlargement, in which the muscle cells of the atria enlarge because they are overworked. This can increase the risk of stroke. Eventually, these cells may die, leading to scarring and heart failure.

To learn more about the rate control medications, see:

To learn about rhythm control medications that have rate-controlling properties, see

To learn more about the downsides of using only a rate control strategy, see Stuck in the Middle: Afib Patients on Rate Control.

If rate control doesn’t work, then your doctor may recommend Rhythm Control Medications or Procedures for Afib, such as catheter ablation or surgery.   

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