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Pharmacological management of heart rate, the mainstay of treatment in patients with atrial fibrillation (AF), is subjected to ongoing controversy.1 Two important questions yet to be answered in ratecontrol therapy are; what constitutes the optimal heart rate during AF and which ratecontrolling drug should be instituted in the individual patient.
Optimal heart rate in AF has been studied in one large randomised trial, the Rate Control Efficacy in Permanent Atrial Fibrillation (RACE II) study, which compared lenient versus strict rate control. RACE II showed that a lenient approach to rate control is easy, safe and effective and should be considered as an initial approach for those with few symptoms.2 However, randomised controlled trials on …
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