What is a common rate-control strategy for atrial fibrillation with rapid ventricular response?

• A. Beta-blockers
• B. Non-dihydropyridine calcium channel blockers
• C. Both A and B
• D. Digoxin only

Answer: (C)

Controlling the ventricular rate in atrial fibrillation with rapid ventricular response is all about slowing conduction through the AV node. Two commonly used and effective options are beta-adrenergic blockers and non-dihydropyridine calcium channel blockers.

Beta-blockers reduce AV nodal conduction by blocking sympathetic stimulation, which lowers heart rate and prolongs the AV nodal refractory period. Non-dihydropyridine calcium channel blockers, such as diltiazem or verapamil, slow AV nodal conduction by inhibiting calcium influx in nodal cells, producing a similar slowing of the ventricular rate. Both classes directly target the pathway controlling how fast the ventricles respond to the rapid atrial impulses, making them standard first-line choices for rate control in AF with RVR.

Digoxin can be useful in certain situations (e.g., in patients with heart failure with reduced ejection fraction or when resting vagal tone predominates), but it has a slower onset and is less reliable for rapid rate control during activity, so it is typically not the sole or primary strategy for acute rate control. Therefore, using either beta-blockers or non-dihydropyridine calcium channel blockers is the common rate-control approach.