BMJ  2007;335:1057-1058 (24 November), doi:10.1136/bmj.39365.511076.BE

Editorials

Rate control in permanent atrial fibrillation

Guidelines on the use of digoxin are inconsistent with evidence from randomised trials

The first 150 words of the full text of this article appear below.

Atrial fibrillation is the most common cardiac arrhythmia and it causes substantial morbidity, especially in elderly people. In June 2006, the UK National Institute for Health and Clinical Excellence (NICE) published new guidelines for control of heart rate in people with chronic atrial fibrillation.¹ The guidelines depart from historical practice by recommending that instead of digoxin, β adrenoceptor blockers or rate limiting calcium antagonists should be the preferred initial monotherapy, except in predominantly sedentary people. Similarly, the revised 2006 joint American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) guidelines recommend the use of β blockers or calcium antagonists alone to control heart rate.² We have reviewed the evidence to support this fundamental change in practice and challenge its safety.

No single definition of ideal control of heart rate in chronic atrial fibrillation exists.³ Rate control drugs aim to reduce heart rate at rest and during exercise, without causing . . . [Full text of this article]

Royal Hallamshire Hospital, Sheffield S10 2JF

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This article has been cited by other articles:

• Segal, O. R (2009). Rate control for atrial fibrillation: one drug or two?. Postgrad. Med. J. 85: 281-282 [Full text]  
• Lip, G. Y H, Rudolf, M., Guideline development group for the NICE clinical, (2007). Rate control and digoxin. BMJ 335: 1169-1170 [Full text]  

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