Beta-blockers in Atrial Fibrillation—Trying to Make Sense of Unsettling Results

Markus Meyer; Daniel Lustgarten


Europace. 2023;25(2):260-262. 

In This Article

Abstract and Introduction


Atrial fibrillation is closely associated with heart failure and adversely affects outcomes. Beta-blockers are strongly recommended to avoid rapid ventricular conduction and tachycardia-induced cardiomyopathy. In this Viewpoint article, we discuss an emerging body of evidence that questions beta-blockers as a preferred rate-control therapy in patients with atrial fibrillation.


Atrial fibrillation co-exists with heart failure and adversely affects morbidity and mortality. Rapid conduction of atrial fibrillation to the ventricles is a common cause of heart failure with a reduced ejection fraction. It is for this reason that the use of atrioventricular node suppressing medications, chief among them beta-blockers, is strongly recommended.[1,2] Without substantiating evidence, it is generally assumed that beta-blockers are beneficial and safe in patients with atrial fibrillation. Herein, we discuss emerging data from randomized studies that should prompt a reappraisal of beta-blockers as a preferred therapy for rate control in atrial fibrillation.