The evidence regarding the drugs used for ventricular rate control

OBJECTIVE Our goal was to determine what drugs are most efficacious for con trolling the ventricular rate in patients with atrial fibrillation. SEARCH STRATEGY We conducted a systematic review of the literature publishe d before May 1998, beginning with searches of The Cochrane Collaboration's CENTRAL database and MEDLINE. SELECTION CRITERIA We included English-language articles describing randomi zed controlled trials of drugs used for heart rate control in adults with a trial Fibrillation, DATA COLLECTION/ANALYSIS Abstracts of trials were reviewed independently by 2 members of the study team. We reviewed English-language abstracts of non -English-language publications to assess qualitative consistency a with our results. MAIN RESULTS Forty-five articles evaluating 17 drugs met our criteria for r eview. In the 5 trials of verapamil and 5 of diltiazem, heart rate was redu ced significantly (P <.05), both at rest and with exercise, compared with p lacebo, with equivalent or improved exercise tolerance in G of 7 comparison s, In 7 of 12 comparisons of a beta-blocker with placebo, the beta-blocker was efficacious for control of resting heart rate, with evidence that the e ffect is drug specific, as nadolol and atenolol proved to be most efficacio us. All 9 comparisons demonstrated good heart rate control with beta-blocke rs during exercise, although exercise tolerance was compromised in 3 of 9 c omparisons. In 7 of 8 trials, digoxin administered alone slowed the resting heart rate more than placebo, but it did not significantly slow the rate d uring exercise in 4 studies, The trials evaluating other drugs yielded insu fficient evidence to support their use, but those drugs may yet be promisin g, CONCLUSIONS The calcium-channel blockers verapamil or diltiazem, or select beta-blockers are efficacious for heart rate control at rest and during exe rcise for patients with atrial fibrillation without a clinically important decrease in exercise tolerance. Digoxin is useful when rate control during exercise is less a concern.