Therapy

Control the ventricular rate ^a using any of

• calcium-channel blockers ^a : verapamil ^a or diltiazem ^a
• beta-blockers ^a : esmolol ^a or sotalol ^a
• clonidine ^b  

Why?

• Calcium channel blockers reduce heart rate both at rest and during exercise compared with placebo. ^a
  • Verapamil slows the ventricular rate (on average by 40 bpm) ^a , but has no clear effect on cardioversion ^d
  • Diltiazem slows the ventricular rate (on average by 20 bpm) ^a
• Beta-blockers reduce heart rate at rest and during exercise compared with placebo, but may reduce exercise tolerance. ^a
  • Esmolol ^a or sotalol ^a slow the ventricular rate, but neither has any clear effect on cardioversion.
• Clonidine slows the ventricular rate ^b

Clonidine slows the ventricular rate

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
fast AF b	oral clonidine	placebo	>20% fall in ventricular rate at 15 minutes at weeks	11%	500% (-11% to 3900%)	2 (1 to 5)