Treatment of Atrial Fibrillation in Persistent AF

Clinical Scenario

Persistent atrial fibrillation describes AF episodes that are not self-terminating — the arrhythmia does not revert spontaneously and requires active clinical management. A structured rate control approach is indicated for this presentation.

Treatment Approach

The first-line strategy is rate control using a single agent, with the choice of agent guided by the patient's cardiac function. The complete selection criteria and clinical algorithm are detailed in the full protocol.

Clinical Target

The initial goal is a resting heart rate of < 110 b.p.m. (lenient control). Stricter rate targets are reserved for patients with continuing AF-related symptoms.

Instant Access to Structured Evidence-Based Regimens

References

AF episodes which are not self-terminating.
Beta-blockers and/or digoxin are recommended in patients with AF and LVEF ≤40% to control heart rate and reduce symptoms.
Beta-blockers, diltiazem, verapamil, or digoxin are recommended as first-choice drugs in patients with AF and LVEF >40% to control heart rate and reduce symptoms.
Lenient rate control with a resting heart rate of < 110 b.p.m. should be considered as the initial target for patients with AF, with stricter control reserved for those with continuing AF-related symptoms.

DOI: 10.1093/eurheartj/ehae176

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