Atrial fibrillation — UKMLA MCQ

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HardCardiologyAtrial fibrillationUKMLA MRCGP AKT PARA MRCEM SBA MRCP Part 1 PSA

A patient with atrial fibrillation and heart failure has an ejection fraction of 30%. Which proposed rate-control drug should generally be avoided because of negative inotropy?

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Correct answer: B — Avoid verapamil for rate control

The best answer is “Avoid verapamil for rate control”. Rate-limiting non-dihydropyridine calcium-channel blockers such as verapamil are generally avoided in heart failure with reduced ejection fraction because negative inotropy can worsen decompensation. A beta-blocker licensed for heart failure or digoxin may be selected according to clinical status, while amiodarone has a specialist role rather than routine long-term rate control.

Reference: NICE NG106: Chronic heart failure in adults: https://www.nice.org.uk/guidance/ng106/chapter/Recommendations