Sandbox/Rate Control Strategy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Rate Control Strategy

Abbreviations: AF: Atrial fibrillation; COPD: Chronic obstructive pulmonary disease; CVD: Cardiovascular disease; EF: Ejection fraction; HFpEF: Heart failure with preserved ejection fraction; HFrEF: Heart failure with reduced ejection fraction; LV: Left ventricle; HF: Heart failure; HR: Heart rate

Stable AF patients requiring heart rate control therapy

Heart rate control strategy: ❑ Resting HR <110 bpm in asymptomatic and EF > 40% patients ❑ Resting HR <80 bpm in symptomatic and EF < 40% patients

Does the patient have any evidence of an accessory pathway (pre-excitation syndrome)?

Yes

No

COPD

HFrEF or LV dysfunction

Hypertension or HFpEF or No CVD

❑ Nondihydropyridine calcium channel blockers: Most preferred OR ❑ Beta blockers ❑ Oral vs IV according to the clinical urgency

❑ Beta blockers: After stabilization in patients with decompensated HF OR ❑ Digoxin ❑ Oral vs IV according to the clinical urgency

❑ Beta blockers OR ❑ Nondihydropyridine calcium channel blockers ❑ Oral vs IV according to the clinical urgency

❑ Procainamide OR ❑ Ibutilide ❑ Oral vs IV according to the clinical urgency

❑ Amiodarone ❑ Oral vs IV according to the clinical urgency

Consider catheter ablation if the accessory pathway has a short refractory period that allows rapid antegrade conduction

References

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