13
Figure 3. Approach to Selecting Drug Therapy for Ventricular
Rate Control
a
Atrial Fibrillation
No Other
Cardiovascular
Disease
Hypertension
or HFpEF
LV
Dysfunction
or HF
COPD
Beta blocker
Diltiazem
Verapamil
Beta blocker
Diltiazem
Verapamil
Beta blocker
b
Digoxin
c
Beta blocker
Diltiazem
Verapamil
Amiodarone
d
a
Drugs are listed alphabetically.
b
Beta blockers should be instituted following stabilization of patients with decompensated HF.
e choice of beta blocker (cardio-selective, etc.) depends on the patient's clinical condition.
c
Digoxin is not usually first-line therapy. It may be combined with a beta blocker and/or a
nondihydropyridine calcium channel blocker when ventricular rate control is insufficient and
may be useful in patients with HF.
d
In part because of concern over its side-effect profile, use of amiodarone for chronic control of
ventricular rate should be reserved for patients who do not respond to or are intolerant of beta
blockers or nondihydropyridine calcium antagonists.
