For a patient with persistent atrial fibrillation and no structural heart disease, which rate-control therapy is considered first-line?

In managing a patient with persistent atrial fibrillation and no structural heart disease, the first-line rate-control therapy typically involves the use of beta-blockers. Metoprolol tartrate is a cardioselective beta-1 adrenergic antagonist, which makes it particularly effective in reducing heart rate by slowing conduction through the sinoatrial node and decreasing myocardial contractility.

The clinical use of beta-blockers, such as metoprolol, is supported by evidence demonstrating their efficacy in controlling ventricular rate during atrial fibrillation, especially among patients without significant coexisting diseases. These agents are often preferred in this patient population due to their established safety profile, and effectiveness, and ability to offer additional cardiovascular protective benefits.

While Calcium channel blockers like diltiazem are also effective in controlling heart rate, beta-blockers are generally more favored first-line agents in this context. Digoxin is less effective for rate control alone and is typically reserved for patients with heart failure or where other options are unsuitable. Amiodarone is primarily an antiarrhythmic agent used for rhythm control rather than solely rate control, making it not the first choice in this scenario. Therefore, metoprolol tartrate is considered the most appropriate first-line therapy for rate