Table 9. Summary of Recommendations for Rate Control.

Recommendations	COR	LOE	References
Control ventricular rate using a beta blocker or nondihydropyridine calcium channel antagonist for paroxysmal, persistent, or permanent AF	I	B	(267-269)
IV beta blockers or nondihydropyridine calcium channel blocker recommended to slow ventricular heart rate in the acute setting in patients without pre-excitation. In hemodynamically unstable patients, electrical cardioversion is indicated	I	B	(270-273)
For AF, assess heart rate control during exertion, adjusting pharmacological treatment as necessary	I	C	N/A
A heart rate control (resting heart rate <80 bpm) strategy is reasonable for symptomatic management of AF	IIa	B	(269, 274)
IV amiodarone can be useful for rate control in critically ill patients without pre-excitation	IIa	B	(275-277)
AV nodal ablation with permanent ventricular pacing is reasonable when pharmacological management is inadequate and rhythm control is not achievable	IIa	B	(278-280)
Lenient rate control strategy (resting heart rate <110 bpm) may be reasonable with asymptomatic patients and LV systolic function is preserved	IIb	B	(274)
Oral amiodarone may be useful for ventricular rate control when other measures are unsuccessful or contraindicated	IIb	C	N/A
AV nodal ablation should not be performed without prior attempts to achieve rate control with medications	III: Harm	C	N/A
Nondihydropyridine calcium channel antagonists should not be used in decompensated HF	III: Harm	C	N/A
With pre-excitation and AF, digoxin, nondihydropyridine calcium channel antagonists, or amiodarone, should not be administered	III: Harm	B	(281)
Dronedarone should not be used to control ventricular rate with permanent AF	III: Harm	B	(282, 283)

AF indicates atrial fibrillation; AV, atrioventricular; COR, Class of Recommendation; HF, heart failure; IV, intravenous; LOE, Level of Evidence; LV, left ventricular; and N/A, not applicable.