Treatment Guidelines from The Medical Letter
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Treatment of Atrial Fibrillation

The treatment of atrial fibrillation includes ventricular rate control, anticoagulation, conversion to normal sinus rhythm and maintenance of sinus rhythm. The choice of therapies that can achieve these goals is discussed in the text that follows. Some drugs are recommended here for indications that have not been approved by the FDA.

RATE CONTROL

In recent years, controlled trials have shown that slowing of the ventricular rate during atrial fibrillation is as effective as rhythm control with cardioversion and/or antiarrhythmic drugs (which can be proarrhythmic) in preventing serious complications and death.1 Therefore, ventricular rate control is now often used as first-line therapy for management of chronic atrial fibrillation, unless symptoms persist.2 Lenient rate control (<110 beats per minute), particularly in patients with a structurally normal heart and no ... more      

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