Rate Control in Patients With Atrial Fibrillation

Study Overview
=================
Brief Summary
-----------------
To search for the best marker for the patients in atrial fibrillation with rate control

Detailed Description
-----------------
In an aging society, the prevalence of atrial fibrillation is increasing. The main treatment strategy is to reduce the complications of embolic stroke and heart failure. Among these patients, a group of them will choose to have rate control based on the heart conditions and the preference of the patients. The strategy is to control the ventricular rate by drugs to prevent the heart from failure. However, when the physicians attempt to do so, they encounter two questions: how much is the optimal drug dose? And what is the best marker we are looking to? To answer these questions, the investigators design a prospective, cross-over study to explore this issue. The participants will do cardiopulmonary exercise test (CPET) before and after treatment. They will receive another CPET if drug dose is titrated up. With the study, the investigators will understand whether a resting heart rate can be a good marker for optimal drug dosage, and what is the optimal range of heart rate the physicians should target.

Official Title
-----------------
The Surrogate Marker of Rate Control in Patients With Atrial Fibrillation

Conditions
-----------------
Atrial Fibrillation, Rate Control, Cardiopulmonary Exercise Test

Intervention / Treatment
-----------------
* Drug: Atenolol, Bisoprolol, Metoprolol, Nebivolol, Propranolol, Diltiazem, Verapamil, digoxin


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 20 90 years old Rate control is preferred after shared decision making Exclusion Criteria: cannot cooperate with or complete CPET has contraindication for CPET, such as uncontrolled heart failure, hypertension, angina, valvular heart disease, lung function impariment that SaO2<90% at room air. Ventricular rate below 80/min before any medication Permanent pacemaker implanted

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 90 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: rate control<br> | Drug: Atenolol, Bisoprolol, Metoprolol, Nebivolol, Propranolol, Diltiazem, Verapamil, digoxin<br>* Start with empirical lower dose for 3 months, and then titrate up<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Maximal Oxygen consumption | acquire the data by Cardiopulmonary exercise test (CPET) with different (low and high) drug dosages for rate control | 0, 3, 6 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Atrial Fibrillation, rate control, cardiopulmonary exercise test