Cardiology  |  Atrial Fibrillation Pathway - Rate Control


Atrial Fibrillation Pathway - Rate Control

Medical Therapy

Consider rate control therapy in all patients with AF:

  • ideally reduce heart rate to <80 beats/min. 
  • in some patients this will not be easily achieved and a rate between 80 and 110 may be acceptable.
  • It may be helpful to check heart rate after gentle exercise.

Medications - all can be used alone or in combination except B blockers + verapamil:

  • B-blockers - metoprolol and atenolol.
  • do not use sotalol  due to the risk of ventricular arrhythmias*
  • calcium channel blockers e.g. diltiazem or verapamil.
  • digoxin - usually second line except in chronic heart failure when 1st line - has a role in sedate or hypotensive patients.

If heart rate is > 110 beats/min despite maximal tolerated therapy, refer to Cardiology Department.

NOTE * Sotalol Warning:
1% risk of ventricular arrhythmias - higher risk elderly patients,patient with structual heart disease, patients with renal impairment.

Other Therapies for AF

AF ablation - pulmonary vein isolation:

  • Is a highly complex procedure quite distinct from other rhythm ablation techniques.
  • Has a higher risk of complications (3% chance of major complication including fatal atrio-oesophageal fistula).

AV nodal ablation with permanent pacemaker implantation:

  • Can be considered in patients with significant ongoing AF control issues despite maximum medical therapy.
  • This procedure renders a patient fully pacemaker dependent.


Rate control medications used in atrial fibrillation


Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.