B. Atenolol – Explanation

Atrial fibrillation: rate control – beta blockers preferable to digoxin

A number of factors including age and symptoms would favour a rate control strategy. The NICE
guidelines suggest either a beta-blocker or a rate limiting calcium channel blocker (i.e. Not
amlodipine) in this situation.
Some clinicians would prefer to use a more cardio-selective beta-blocker such as bisoprolol,
although this is not stipulated in current guidelines
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 rateduring 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