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Atrial fibrillation - Management
How should I manage someone after starting initial rate-control treatment?

  • Within 1 week, check whether the person is tolerating the drug and review symptoms, heart rate, and blood pressure.
  • If the person cannot tolerate the drug, prescribe an alternative (see Initial drug treatment for rate control).
  • If the person's symptoms and/or heart rate are not controlled:
    • If they are not taking the maximum drug dose, consider increasing the dose to control symptoms, or
    • If they are taking the maximum drug dose, consider combining drug treatments:
      • To control symptoms during normal activities only, use a beta-blocker or calcium-channel blocker (diltiazem or verapamil) with digoxin.
      • To control symptoms during normal activities and during exercise, use a calcium-channel blocker (diltiazem or verapamil) with digoxin. If the person is already taking a beta-blocker, it may be more practical to add in digoxin first, and if symptoms are still not controlled, then switch the beta-blocker with a calcium-channel blocker.
  • Do not use a combination of a beta-blocker and a rate-limiting calcium-channel blocker to control atrial fibrillation in primary care.
    • If symptoms are not controlled with a beta-blocker plus digoxin or a calcium-channel blocker plus digoxin, refer to a specialist in cardiology.
  • For detailed prescribing information, see the prescribing sections on beta-blockers, calcium-channel blockers, and digoxin.

In depth

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