{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T16:11:31Z","timestamp":1778256691458,"version":"3.51.4"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":46,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005075","name":"University Medical Center Groningen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005075","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"Abstract<\/jats:title>\n \n Aims<\/jats:title>\n Controlling heart rate is a key objective in atrial fibrillation (AF) management, commonly achieved with beta blockers or non-dihydropyridine calcium channel blockers, both class I guideline recommendations. However, their long-term effectiveness has rarely been compared. This review aimed to critically evaluate all available evidence comparing these drug classes in AF treatment.<\/jats:p>\n <\/jats:sec>\n \n Methods and results<\/jats:title>\n We systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central for original studies published up to 1 March 2025. Eligible studies included AF patients, compared calcium channel blockers and beta blockers, and reported heart rate or other clinically relevant outcomes. The primary outcome was 24-hour heart rate on Holter monitoring. Meta-analyses were performed where data were sufficiently homogeneous. Of 1906 identified records, 25 met inclusion criteria. Five studies reported 24-h mean heart rate, showing no difference between drug classes (mean difference: 3.6 b.p.m., 95% CI: \u22122.9 to 10.1, P = 0.274). Eight studies reported maximum exercise heart rate, which was significantly higher with calcium channel blockers than with beta blockers (mean difference: 10.5\u2005b.p.m., 95% CI: 3.3 to 17.7, P = 0.043). Other outcomes were too heterogeneous for meta-analysis, though three studies reported increased peak oxygen uptake with calcium channel blockers.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Calcium channel blockers and beta blockers provide comparable control of mean heart rate in AF. However, patients on calcium channel blockers have a higher maximum heart rate during exercise. In our qualitative synthesis, some studies reported higher peak oxygen uptake calcium channel blocker treated patients, these results should be seen as hypothesis generating.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeag062","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:27:29Z","timestamp":1776166049000},"source":"Crossref","is-referenced-by-count":0,"title":["Rate control treatment with calcium channel blockers and beta blockers for patients with atrial fibrillation: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-3410","authenticated-orcid":false,"given":"Tim","family":"Koldenhof","sequence":"first","affiliation":[{"name":"Department of Cardiology, Martini Hospital , Van Swietenplein 1, Groningen 9728 NT ,","place":["The Netherlands"]},{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-9176","authenticated-orcid":false,"given":"Barzi","family":"Gareb","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ, Groningen ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9608-8873","authenticated-orcid":false,"given":"Marcelle D","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Martini Hospital , Van Swietenplein 1, Groningen 9728 NT ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thijmen S A","family":"Bergwerff","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-070X","authenticated-orcid":false,"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7654-2098","authenticated-orcid":false,"given":"Robert G","family":"Tieleman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Martini Hospital , Van Swietenplein 1, Groningen 9728 NT ,","place":["The Netherlands"]},{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026050811332100900_oeag062-B1","first-page":"3314","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026050811332100900_oeag062-B2","first-page":"818","article-title":"Rate control in atrial fibrillation","volume":"388","author":"Van Gelder","year":"2016","journal-title":"Lancet"},{"key":"2026050811332100900_oeag062-B3","first-page":"225","article-title":"Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation","volume":"111","author":"Ulimoen","year":"2013","journal-title":"Am J Cardiol"},{"key":"2026050811332100900_oeag062-B4","first-page":"175","article-title":"Diltiazem vs. Metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department","volume":"49","author":"Fromm","year":"2015","journal-title":"J Emerg Med"},{"key":"2026050811332100900_oeag062-B5","first-page":"467","article-title":"What is the best agent for rate control of atrial fibrillation with rapid ventricular response?","volume":"63","author":"Long","year":"2022","journal-title":"J Emerg Med"},{"key":"2026050811332100900_oeag062-B6","first-page":"148","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"2026050811332100900_oeag062-B7","doi-asserted-by":"publisher","first-page":"174749301989787","DOI":"10.1186\/s13643-025-03035-3","article-title":"Comparison of non-dihydropyridine calcium channel blockers with beta blockers as treatment for atrial fibrillation: protocol for a systematic review with meta-analysis","volume":"15","author":"Koldenhof","year":"2026","journal-title":"Systematic Reviews"},{"key":"2026050811332100900_oeag062-B8","first-page":"529","article-title":"Treatment of chronic atrial fibrillation in the elderly, assessed by ambulatory electrocardiographic monitoring","volume":"28","author":"Wang","year":"1980","journal-title":"J Am Geriatr Soc"},{"key":"2026050811332100900_oeag062-B9","first-page":"167","article-title":"Comparative study of efficacy and safety of low-dose diltiazem or betaxolol in combination with digoxin to control ventricular rate in chronic atrial fibrillation: randomized crossover study","volume":"52","author":"Koh","year":"1995","journal-title":"Int J Cardiol"},{"key":"2026050811332100900_oeag062-B10","first-page":"88","article-title":"Efficacy and safety of digoxin alone and in combination with low-dose diltiazem or betaxolol to control ventricular rate in chronic atrial fibrillation","volume":"75","author":"Koh","year":"1995","journal-title":"Am J Cardiol"},{"key":"2026050811332100900_oeag062-B11","first-page":"304","article-title":"Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens","volume":"33","author":"Farshi","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"2026050811332100900_oeag062-B12","first-page":"965","article-title":"Rate control and quality of life in patients with permanent atrial fibrillation: the quality of life and atrial fibrillation (QOLAF) study","volume":"70","author":"Tsuneda","year":"2006","journal-title":"Circ J"},{"key":"2026050811332100900_oeag062-B13","first-page":"97","article-title":"Perceived exertion and gas exchange after calcium and beta-blockade in atrial fibrillation","volume":"63","author":"Myers","year":"1987","journal-title":"J Appl Physiol"},{"key":"2026050811332100900_oeag062-B14","first-page":"453","article-title":"Effects of digoxin, propranolol, and verapamil on exercise in patients with chronic isolated atrial fibrillation","volume":"25","author":"Matsuda","year":"1991","journal-title":"Cardiovasc Res"},{"key":"2026050811332100900_oeag062-B15","first-page":"280","article-title":"Effects of diltiazem, propranolol, and their combination in the control of atrial fibrillation","volume":"15","author":"Dahlstrom","year":"1992","journal-title":"Clin Cardiol"},{"key":"2026050811332100900_oeag062-B16","first-page":"515","article-title":"Diltiazem reduces levels of NT-proBNP and improves symptoms compared with metoprolol in patients with permanent atrial fibrillation","volume":"10","author":"Enge","year":"2024","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2026050811332100900_oeag062-B17","author":"Higgins"},{"key":"2026050811332100900_oeag062-B18","first-page":"29","article-title":"A new tool to assess clinical diversity in meta-analyses (CDIM) of interventions","volume":"135","author":"Barbateskovic","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"2026050811332100900_oeag062-B19","author":"Schwarzer"},{"key":"2026050811332100900_oeag062-B20","author":"Sch\u00fcnemann"},{"key":"2026050811332100900_oeag062-B21","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026050811332100900_oeag062-B22","first-page":"517","article-title":"Calcium channel blockers improve exercise capacity and reduce N-terminal pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation","volume":"35","author":"Ulimoen","year":"2014","journal-title":"Eur Heart J"},{"key":"2026050811332100900_oeag062-B23","first-page":"137","article-title":"Rate-control drugs affect variability and irregularity measures of RR intervals in patients with permanent atrial fibrillation","volume":"26","author":"Corino","year":"2015","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026050811332100900_oeag062-B24","first-page":"79","article-title":"Troponin I levels in permanent atrial fibrillation-impact of rate control and exercise testing","volume":"16","author":"Horjen","year":"2016","journal-title":"BMC Cardiovasc Disord"},{"key":"2026050811332100900_oeag062-B25","first-page":"83","article-title":"Improved control of atrial fibrillation with combined pindolol and digoxin therapy","volume":"10","author":"James","year":"1989","journal-title":"Eur Heart J"},{"key":"2026050811332100900_oeag062-B26","first-page":"1201","article-title":"The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study: approaches to control rate in atrial fibrillation","volume":"43","author":"Olshansky","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2026050811332100900_oeag062-B27","first-page":"1510","article-title":"Role of the atrial rate as a factor modulating ventricular response during atrial fibrillation","volume":"33","author":"Climent","year":"2010","journal-title":"Pacing Clin Electrophysiol"},{"key":"2026050811332100900_oeag062-B28","first-page":"222","article-title":"Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness","volume":"20","author":"Scheuermeyer","year":"2013","journal-title":"Acad Emerg Med"},{"key":"2026050811332100900_oeag062-B29","first-page":"652","article-title":"Outcomes of rate-control treatment in patients with atrial fibrillation and heart failure\u2014a nationwide cohort study","volume":"82","author":"Yu","year":"2018","journal-title":"Circ J"},{"key":"2026050811332100900_oeag062-B30","first-page":"1825","article-title":"Rate control and clinical outcomes in patients with atrial fibrillation and obstructive lung disease","volume":"15","author":"You","year":"2018","journal-title":"Heart Rhythm"},{"key":"2026050811332100900_oeag062-B31","first-page":"328","article-title":"A comparison of rate control agents for the treatment of atrial fibrillation: follow-up investigation of the AFFIRM study","volume":"26","author":"Zaman","year":"2021","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"2026050811332100900_oeag062-B32","first-page":"384","article-title":"Rate control drugs differ in the prevention of progression of atrial fibrillation","volume":"24","author":"Koldenhof","year":"2022","journal-title":"EP Eur"},{"key":"2026050811332100900_oeag062-B33","first-page":"752","article-title":"Comparison of rate control efficacy between beta-blockers and calcium channel blockers in patients hospitalized with atrial fibrillation","volume":"24","author":"Sherf","year":"2022","journal-title":"Isr Med Assoc J"},{"key":"2026050811332100900_oeag062-B34","first-page":"e24257","article-title":"Comparison between beta-blockers and calcium channel blockers in patients with atrial fibrillation according to renal function","volume":"47","author":"Parada Barcia","year":"2024","journal-title":"Clin Cardiol"},{"key":"2026050811332100900_oeag062-B35","first-page":"101117","article-title":"Incidence of all-cause, cardiovascular, and atrial fibrillation-related hospitalizations: focus on antiarrhythmic drugs","volume":"3","author":"Menichelli","year":"2024","journal-title":"JACC Adv"},{"key":"2026050811332100900_oeag062-B36","first-page":"1759","article-title":"Rate control in atrial fibrillation, calcium channel blockers versus beta-blockers","volume":"109","author":"Koldenhof","year":"2023","journal-title":"Heart"},{"key":"2026050811332100900_oeag062-B37","first-page":"422","article-title":"Improved rate control reduces cardiac troponin T levels in permanent atrial fibrillation","volume":"37","author":"Ulimoen","year":"2014","journal-title":"Clin Cardiol"},{"key":"2026050811332100900_oeag062-B38","first-page":"248","article-title":"Intravenous diltiazem versus metoprolol for atrial fibrillation with rapid ventricular rate: a meta-analysis","volume":"51","author":"Lan","year":"2022","journal-title":"Am J Emerg Med"},{"key":"2026050811332100900_oeag062-B39","first-page":"494","article-title":"Comparison of diltiazem and metoprolol for atrial fibrillation with rapid ventricular rate: systematic review and meta-analysis","volume":"74","author":"Sharda","year":"2022","journal-title":"Indian Heart J"},{"key":"2026050811332100900_oeag062-B40","first-page":"230","article-title":"Metoprolol vs diltiazem for atrial fibrillation with rapid ventricular rate: systematic review and meta-analysis of adverse events","volume":"89","author":"Hintze","year":"2025","journal-title":"Am J Emerg Med"},{"key":"2026050811332100900_oeag062-B41","first-page":"1307","article-title":"The current status of beta blockers\u2019 use in the management of hypertension","volume":"35","author":"Akbar","year":"2014","journal-title":"Saudi Med J"},{"key":"2026050811332100900_oeag062-B42","first-page":"103","article-title":"Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment","volume":"18","author":"Ziff","year":"2020","journal-title":"BMC Med"},{"key":"2026050811332100900_oeag062-B43","first-page":"2042","article-title":"Effect of \u03b2-blocker withdrawal on functional capacity in heart failure and preserved ejection fraction","volume":"78","author":"Palau","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026050811332100900_oeag062-B44","first-page":"117","article-title":"Relative impairments in hemodynamic exercise reserve parameters in heart failure with preserved ejection fraction: a study-level pooled analysis","volume":"6","author":"Pandey","year":"2018","journal-title":"JACC Hear Fail"},{"key":"2026050811332100900_oeag062-B45","first-page":"120","article-title":"Deleterious effects of \u03b2-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension","volume":"130","author":"Provencher","year":"2006","journal-title":"Gastroenterology"}],"container-title":["European Heart Journal Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeag062\/68089499\/oeag062.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/6\/2\/oeag062\/68089499\/oeag062.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/6\/2\/oeag062\/68089499\/oeag062.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:33:27Z","timestamp":1778254407000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjopen\/article\/doi\/10.1093\/ehjopen\/oeag062\/8654892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":45,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjopen\/oeag062","relation":{},"ISSN":["2752-4191"],"issn-type":[{"value":"2752-4191","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"oeag062"}}