{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:45:28Z","timestamp":1791895528411,"version":"4.3.4"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"1004","license":[{"start":{"date-parts":[[2009,6,1]],"date-time":"2009-06-01T00:00:00Z","timestamp":1243814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Recent guidelines by the National Institute for Health and Clinical Excellence (NICE) and the American College of Cardiology\/American Heart Association\/European Society of Cardiology (ACC\/AHA\/ESC) on rate control management for chronic atrial fibrillation have relegated digoxin to second line treatment, recommending instead the use of \u03b2-blockers or rate limiting calcium antagonists as first line treatment. The objective of this review is to assess the efficacy of these drugs in controlling heart rate, and in improving symptoms and exercise tolerance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data sources<\/jats:title>\n                  <jats:p>We electronically searched the Medline, Embase and Cochrane databases, hand searched journals and relevant bibliographies for articles.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Selection of studies<\/jats:title>\n                  <jats:p>We included all study designs evaluating or comparing oral digoxin, \u03b2-blockers and calcium antagonists, alone or in combination, for rate control in chronic atrial fibrillation. 46 studies satisfied our inclusion and quality criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Published studies are small and too heterogeneous to be quantitatively combined. Descriptive synthesis of the data shows little evidence that monotherapy with \u03b2-blockers or calcium antagonists improves symptoms or exercise capacity in patients with chronic atrial fibrillation. Instead it is associated with dose related side effects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Based on the limited data available, we conclude that the combination of digoxin with either a \u03b2-blocker or calcium antagonist should be first line management in patients with chronic atrial fibrillation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/pgmj.2008.068908","type":"journal-article","created":{"date-parts":[[2009,6,15]],"date-time":"2009-06-15T17:38:07Z","timestamp":1245087487000},"page":"303-312","source":"Crossref","is-referenced-by-count":38,"title":["Chronic atrial fibrillation: a systematic review of medical heart rate control management"],"prefix":"10.1093","volume":"85","author":[{"given":"T","family":"Nikolaidou","sequence":"first","affiliation":[{"name":"Cardiology Department, Royal Hallamshire Hospital , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K S","family":"Channer","sequence":"additional","affiliation":[{"name":"Cardiology Department, Royal Hallamshire Hospital , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2009,6,15]]},"reference":[{"key":"2023041909291294000_b1","volume-title":"Atrial fibrillation: national clinical guideline for management in primary and secondary care","author":"National Collaboration Centre for Chronic Conditions","year":"2006"},{"key":"2023041909291294000_b2","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.jacc.2006.07.009","article-title":"ACC\/AHA\/ESC 2006 guidelines for the management of patients with atrial fibrillation\u2014executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation)","volume":"48","author":"Fuster","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2023041909291294000_b3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.1365-2125.1991.tb03898.x","article-title":"The drug treatment of atrial fibrillation","volume":"32","author":"Channer","year":"1991","journal-title":"Br J Clin Pharmacol"},{"key":"2023041909291294000_b4","first-page":"47","article-title":"The evidence regarding the drugs used for ventricular rate control","volume":"49","author":"Segal","year":"2000","journal-title":"J Fam Pract"},{"key":"2023041909291294000_b5","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.amjcard.2003.10.013","article-title":"Rate control in patients with chronic atrial fibrillation","volume":"93","author":"Bjerregaard","year":"2004","journal-title":"Am J Cardiol"},{"key":"2023041909291294000_b6","first-page":"1252","article-title":"[Comparison between digoxin and atenolol in chronic atrial fibrillation]","volume":"123","author":"Lanas","year":"1995","journal-title":"Rev Med Chil"},{"key":"2023041909291294000_b7","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S0895-4356(98)00131-0","article-title":"The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus","volume":"51","author":"Verhagen","year":"1998","journal-title":"J Clin Epidemiol"},{"key":"2023041909291294000_b8","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1378\/chest.111.4.934","article-title":"Oxygen uptake kinetics and cardiopulmonary performance in lone atrial fibrillation and the effects of sotalol","volume":"111","author":"Lok","year":"1997","journal-title":"Chest"},{"key":"2023041909291294000_b9","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1388-9842(02)00031-4","article-title":"Is beta-blockade useful in heart failure patients with atrial fibrillation? 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