Rate control in atrial fibrillation: targets, methods, resynchronization considerations.

Controlling the ventricular rate during both paroxysmal and persistent atrial fibrillation (AF), initially with digitalis preparations and subsequently with -blockers and calcium channel blockers, has been a mainstay for the management of this arrhythmia for many years. With the advent of a wide range of pharmacological and nonpharmacological approaches for maintaining sinus rhythm, rhythm control strategies have entered widespread clinical use in selected subsets of symptomatic patients. Despite the availability of these rhythm control strategies, however, rate control of AF remains an important and useful approach for a large number of patients, especially those with little or no symptoms from the arrhythmia once the ventricular rate has been controlled. This review discusses the relative risks and benefits of rate versus rhythm control strategies, describes the targets and available methods for rate control, and highlights special considerations for ventricular rate control when cardiac resynchronization therapy (CRT) is used in patients with AF.