D. Age > 65 years – Explanation
Atrial fibrillation: rate control and maintenance of sinus rhythm
The Royal College of Physicians and NICE published guidelines on the management of atrial
fibrillation (AF) in 2006. The following is also based on the joint American Heart Association (AHA),
American College of Cardiology (ACC) and European Society of Cardiology (ESC) 2012 guidelines
Agents used to control rate in patients with atrial fibrillation
- beta-blockers
- calcium channel blockers
- digoxin (not considered first-line anymore as they are less effective at controlling the heart rate
during exercise. However, they are the preferred choice if the patient has coexistent heart failure)
Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation
- sotalol
- amiodarone
- flecainide
- others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine
The table below indicates some of the factors which may be considered when considering either a
rate control or rhythm control strategy
| Factors favouring rate control | Factors favouring rhythm control |
| Older than 65 years History of ischaemic heart disease |
Precipitant (e.g. Younger than 65 years Symptomatic First presentation Lone AF or AF secondary to a corrected Alcohol) Congestive heart failure |
