What is the best beta blocker (BB) for atrial fibrillation (AFib)?

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Last updated: March 1, 2025 • View editorial policy

From the Research

The most effective beta blocker for atrial fibrillation is metoprolol, due to its ability to control ventricular rate and improve symptoms, as shown in a study published in the American journal of cardiovascular drugs 1.

Key Points to Consider

  • Beta-blockers are effective in maintaining sinus rhythm and controlling the ventricular rate during atrial fibrillation, with metoprolol being a commonly used option 1.
  • The choice of beta-blocker should be individualized based on comorbidities, with cardioselective agents (metoprolol, bisoprolol, atenolol) generally preferred in patients with respiratory conditions like asthma or COPD.
  • For patients with coexisting heart failure, carvedilol or bisoprolol may be preferred due to their proven mortality benefits in heart failure, as demonstrated in a study published in the Journal of the American College of Cardiology 2.
  • A study published in the European heart journal found that treatment with carvedilol compared to metoprolol offers additional benefits among patients with atrial fibrillation, particularly in terms of mortality reduction 3.

Important Considerations

  • Beta-blockers work by blocking beta-adrenergic receptors in the heart, slowing the heart rate and reducing the force of contractions, which helps control rapid ventricular rates often seen in AFib.
  • Side effects may include fatigue, dizziness, and bradycardia, so regular monitoring is important, especially during dose adjustments.
  • Atrial fibrillation is associated with increased morbidity and mortality, and beta-blockers have been shown to improve symptoms and survival in patients with heart failure, as demonstrated in a study published in Cardiac electrophysiology review 4.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.