It is important to keep the heart rate under control when AF is diagnosed. This is partly because a high heart rate is often responsible for being aware of AF or having symptoms as a result. In addition, if the heart rate is poorly controlled for longer periods of time, this can affect the heart’s pumping function.
The first-line therapy for heart rate control is usually a beta-blocker, such as bisoprolol, metoprolol, carvedilol or atenolol. The aim is to get the heart rate between 60 and 100 beats per minute most of the time, especially when at rest. If beta-blockers cause side effects (such as fatigue, lethargy, problems with sleeping or sex drive) then a reasonable alternative is a calcium channel blocker such as verapamil or diltiazem.
Sometimes digoxin is added in addition to either a beta-blocker or calcium channel blocker in order to optimise heart rate control.
If it is clear that a benefit is derived in terms of symptoms and quality of life by restoring an maintaining sinus rhythm, then other medications such as flecainide, sotalol or amiodarone may be recommended in order to facilitate this.