Long term management of stable but symptomatic atrial fibrillation?

Which of the following is a first-line drug for rate control in the longer term management of stable but symptomatic atrial fibrillation:

A. Verapamil
B. Quinidine
C. Digoxin
D. Procainamide
E. Amiodarone

 Answer : A. Verapamil

Discussion:

The long-term goal of management for stable but symptomatic atrial fibrillation is rate control in most patients. Although a wide variaty of agents are used, beta-blockers and calcium channel blockers such as diltiazem are preferred. 

Because of digoxin's side effect profile, and lower efficacy, most experts now recommend digoxin as second-line therapy for atrial fibrillation. 

Procainamide does not control ventricular response rate. 

Quinidine is not indicated for rate control. 

Amiodarone may be useful in select patients, but side effects limit its tolerability.

 Anticoagulation is another important consideration. In low-risk patients without risk factors, aspirin alone might be sufficient. For most medium- or high-risk patients, anticoagulation with warfarin to achieve a target INR of 2.5 is recommended.