[Pharmacological rate control therapy for atrial fibrillation].

Many studies have reported that there is no significant difference in survival rate between rhythm control and rate control strategies in combination of with anticoagulation in patients with atrial fibrillation. Even in patients with atrial fibrillation and with heart failure there is no significant difference in survival rate between both strategies. There is no need of strict rate control. In patients with permanent atrial fibrillation, lemient rate control(resting heart rate of below 110 beats per minute) is as effective as strict rate control (< 70 beats per minute) and easier to achieve. Digitalis, beta-blockers and Ca channel blockers are used for rate control treatments. Digitalis is the only drug that has both decreasing ventricular response by suppressing atrioventricular conduction and inotropic effects. However, digitalis can not suppress heart rates during exercise. Beta-blockers and Ca channel blockers can suppress heart rates not only at rest but also during exercise. Ca channel blockers can not be used for patients with heart failure due to reduction in contractility of heart muscle. It has been reported that cardiac function and survival rate can be improved by beta-blockers in patients with heart failure if starting low dose and increasing gradually.