Which initial drug treatment should I offer for rate control of atrial fibrillation?
• Offer a beta-blocker or rate-limiting calcium-channel blocker (diltiazem or verapamil), unless this is contraindicated. • The choice between beta-blocker and calcium-channel blocker will depend on the person’s current medication and comorbidities. • Diltiazem (off-licensed use for atrial fibrillation) is preferred to verapamil because verapamil has a greater negative inotropic effect on the heart and interacts with digoxin. • For further information, see the prescribing sections on beta-blockers and calcium-channel blockers. • If the person has a sedentary lifestyle, digoxin is an alternative option. • Digoxin is only adequate for older, sedentary people in whom rate control is not needed during exercise. • For further information, see the prescribing section on digoxin.