Rate control is achieved with medications that work by increasing the degree of block at the level of the AV node, effectively decreasing the number of impulses that conduct down into the ventricles. This can be done withRate control medications, such as Lanoxin (digoxin), beta-blockers (example: metoprolol, atenolol, bisoprolol) and calcium channel blockers (example: verapamil, diltiazem), are used to help slow the heart rate during atrial fibrillation. These medications do not control the heart rhythm. In addition to these agents, amiodarone has some AV node blocking effects (particularly when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).

Pitfalls of Rate vs Rhythm control studies: In most of these trials like the AFFIRM, AF-CHF were not true comparisons of rhythm control vs rate control. These were mere comparisons of ATTEMPTED rhythm control vs rate control. Sinus rhythm rates in the rhythm control arm were very LOW. AFFIRM, RACE and STAF did not include many AF patients. Patients with frequent or severe symptoms might have been considered unsuitable...and therefore may not have been enrolled. Most of these trials had limited, unsuccessful AAD choices. The toxic effects of AADs in rhythm control arm should considered seriously. AF may be a marker of poor prognosis, in which the primary problem is poor ventricular function, neurohormonal activation, or inflammation, with no independent effect of AF on outcome. So the lack of significant differences in outcomes with attempted rhythm control with drugs does not mean that rhythm control doesn't work. However, it does highlight the fact that rhythm control without the sideeffect profile of the drugs could be beneficial. And such a thing could be accomplished with either cateter based ablation techniques and/or surgery.