What are the first-line treatment options for rate control of atrial fibrillation?
The first-line treatment options for rate control of atrial fibrillation are either a standard beta-blocker (that is, a beta-blocker other than sotalol) or a rate-limiting calcium-channel blocker (diltiazem or verapamil), unless the person has the features described in recommendation 1.7.4. Digoxin monotherapy may also be considered for initial rate control for people with non-paroxysmal atrial fibrillation if the person does no or very little physical exercise or other rate-limiting drug options are ruled out because of comorbidities or the person's preferences. If monotherapy does not control the person's symptoms, and if continuing symptoms are thought to be caused by poor ventricular rate control, combination therapy with any two of a beta-blocker, diltiazem, and digoxin may be considered. Amiodarone should not be offered for long-term rate control. 