Beta-blocker therapy in atrial fibrillation

Beta-blocking agents are a generally established therapy to achieve rate control in patients with AF. With the widely spread belief that rhythm control is the therapy of choice, their use is currently limited to patients that were considered not suitable for specific antiarrhythmic drug therapy. In contrast to that belief, recent studies show that beta-blockers do have some benefit in maintaining sinus rhythm or reducing the frequency of paroxysmal AF and that this benefit might be comparable to conventionally used antiarrhythmic drugs, with the exception of amiodarone. In addition, four prospectively randomized studies recently presented concluded that rate control may be an appropriate aim as a first line approach in patients with AF. Hence, an increased use of beta-blockers in the treatment of patients with AF is to be expected, given the proven prognostic benefit of these drugs in many cardiovascular disorders that are associated with AF. However, no prospective study has yet proven that beta-blockers do exert the same benefit in patients in AF, and one retrospective analysis suggests that there may be differences with regard to the potential benefits of beta-blocker therapy when patients are in AF compared to sinus rhythm. The article summarizes available clinical studies and reviews some experimental data examining the treatment effects of antiadrenergic therapy in AF.