In stable patients with atrial fibrillation and rapid ventricular response, which medications can be given?

In patients presenting with stable atrial fibrillation and a rapid ventricular response, the primary goal is to control the heart rate to improve symptoms and prevent potential complications. The most effective classes of medications for this purpose are beta blockers and calcium channel blockers.

Beta blockers, such as metoprolol or esmolol, work by reducing the heart rate through their action on the beta-adrenergic receptors, leading to decreased conduction through the AV node. Calcium channel blockers, particularly non-dihydropyridines like diltiazem and verapamil, also decrease heart rate by reducing calcium influx in myocardial and pacemaker cells, which similarly slows conduction and can alleviate symptoms associated with rapid ventricular rates.

While other medications like anticoagulants or anticoagulants might be necessary in the overall management of atrial fibrillation to prevent thromboembolic events, their primary function does not involve immediate rate control during rapid ventricular response episodes. Likewise, diuretics and ACE inhibitors are not indicated for acute rate control in this situation. Finally, amiodarone and digoxin can be used in certain cases of atrial fibrillation, particularly if there's a need for rhythm control, but they are generally not the first-line options for the immediate