Who, when and how to rate control for atrial fibrillation

PURPOSE OF REVIEW: The aim of this review is to provide a perspective on rate control in atrial fibrillation, in the era after the large randomized trials comparing rate and rhythm control. This review emphasizes the indications for rate control, the optimal heart rate and the different treatment modalities. RECENT FINDINGS: Large studies have shown that rate control is not inferior to rhythm control with regard to cardiovascular morbidity and mortality. Rate control may now be instituted earlier during the course of the disease, even as first-choice therapy in some patients, particularly those with hypertension and underlying heart diseases, and those who are not (severely) symptomatic. The goals of rate-control therapy are to reduce symptoms, improve quality of life, minimize the development of heart failure, and prevent thromboembolic complications. An important negative aspect of rate-control therapy is the side effects of drugs. The optimal heart rate during atrial fibrillation has not yet been carefully investigated. Several approaches to control rate during atrial fibrillation are available, including pharmacological rate control and atrioventricular nodal ablation with pacemaker implantation. SUMMARY: Understanding the indications for rate control, treatment goals and options will gain the largest benefit for the individual patient with atrial fibrillation.