From the Guidelines
For patients with atrial fibrillation, the initial target heart rate should be reduced to less than 110 beats per minute at rest, according to the most recent and highest quality study 1. This approach is recommended as a lenient target heart rate, and when symptoms persist, a lower heart rate might be attempted but at the same time bradycardia avoided. The goal of rate control is to alleviate symptoms and prevent complications, and the specific target heart rate may vary based on individual patient characteristics, such as symptoms and comorbidities. Some studies suggest that a resting heart rate below 80 beats per minute and below 110 beats per minute during moderate activity may be appropriate 1. However, the most recent and highest quality study 1 recommends a lenient target heart rate of less than 110 beats per minute at rest, which should be the primary goal for patients with atrial fibrillation. Key considerations for rate control include:
- Using medications such as beta-blockers, calcium channel blockers, or digoxin to achieve rate control
- Monitoring heart rate regularly with an EKG or home pulse check to ensure the target range is maintained
- Adjusting the target heart rate based on individual patient symptoms and comorbidities
- Avoiding bradycardia when attempting to lower the heart rate. By prioritizing a lenient target heart rate of less than 110 beats per minute at rest, healthcare providers can help alleviate symptoms and prevent complications in patients with atrial fibrillation, ultimately improving morbidity, mortality, and quality of life.
From the Research
Goal Heart Rate for Atrial Fibrillation
- The goal heart rate for patients with atrial fibrillation (AF) at rest is between 60 to 80 beats/min, and 90 to 115 beats/min at moderate exercise, as recommended by clinical practice guidelines 2.
- A study found that the median heart rate at rest was 80 beats/min, which is at the upper end of the recommended range, and only patients administered a beta blocker had lower median heart rates at rest 2.
- The median heart rate at moderate exercise was 128 beats/min, which is higher than the recommended range, and only patients administered a beta blocker had significantly reduced heart rates at moderate exercise 2.
Comparison of Rate Control Efficacy
- A study compared the efficacy of beta-blockers and calcium channel blockers for rate control in patients with AF, and found that beta-blockers were more effective in reducing heart rate and shortening hospitalization duration 3.
- Another study found that intravenous metoprolol and diltiazem had similar efficacy and safety for rate control in patients with AF, and no patient-specific factors were identified that would influence the preferential use of one medication over the other 4.
- A retrospective cohort study found that patients with AF and no acute underlying medical illness who received calcium channel blockers had similar hospital admission rates and safety outcomes compared to those who received beta-blockers 5.
Optimal Resting Heart Rate
- A post hoc analysis of the AFFIRM trial found that an optimal resting heart rate of 70 bpm was associated with lower all-cause mortality in patients with AF and coronary heart disease 6.
- The study suggested that patients with a resting heart rate below 70 bpm had lower all-cause mortality than those with a resting heart rate above 70 bpm 6.