INTRODUCTION: Atrial fibrillation is a supraventricular tachyarrhythmia, which 
is characterised by the presence of fast and uncoordinated atrial activation 
leading to reduced atrial mechanical function. Risk factors for atrial 
fibrillation include increasing age, coexisting cardiac and thyroid disease, 
pyrexial illness, electrolyte imbalance, cancer, and coexisting infection.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the 
following clinical questions: What are the effects of oral medical treatments to 
control heart rate in people with chronic (defined as longer than 1 week for 
this review) non-valvular atrial fibrillation? What is the effect of different 
treatment strategies (rate vs. rhythm) for people with persistent non-valvular 
atrial fibrillation? We searched: Medline, Embase, The Cochrane Library and 
other important databases up to August 2007 (Clinical Evidence reviews are 
updated periodically, please check our website for the most up-to-date version 
of this review). We included harms alerts from relevant organisations such as 
the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare 
products Regulatory Agency (MHRA).
RESULTS: We found 18 systematic reviews, RCTs, or observational studies that met 
our inclusion criteria. We performed a GRADE evaluation of the quality of 
evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the 
effectiveness and safety of the following interventions: beta-blockers (with or 
without digoxin), calcium channel blockers (with or without digoxin), calcium 
channel blockers (rate limiting), digoxin, and rate versus rhythm control 
strategies.