Slowing down the heart rate in permanent atrial fibrillation

Abstract

This editorial refers to ‘Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation’, by S.R. Ulimoen et al. doi:10.1093/eurheartj/eht429 Ventricular rate control for atrial fibrillation (AF) is almost as old as the first records of the disease. While digitalis has been the focus of classical observations,1 this substance is currently losing relevance for AF ventricular rate control owing to uncertainties regarding its prognostic value. Recent studies and retrospective analyses of older trials have shed an unfavourable light on digitalis in AF patients, in particular if serum concentrations are elevated.2,3 In general, rate control aims at reducing symptoms and improving exercise capacity. It is recommended as initial treatment for all patients with AF.4 While symptomatic patients with paroxysmal and persistent AF should subsequently undergo further rhythm control actions, patients with permanent AF (as per definition) will remain on rate control medication. Rate control is non-inferior to rhythm control with respect to mortality in patients with different types of AF and with or without heart failure (HF).5,6 Data regarding the impact of rate control on mortality are …