A stable 61-year-old woman with permanent atrial fibrillation and preserved ejection fraction is well controlled on metoprolol. According to the ESC 2020 guidelines, which resting heart rate target defines adequate LENIENT rate control for her?

• A Below 80 bpm at rest
• B Below 110 bpm at rest ✓
• C Below 100 bpm at rest
• D Below 130 bpm at rest

Explanation

The ESC 2020 AF guideline endorses a lenient resting rate target of under 110 bpm based on the RACE II trial, which showed that strict control (under 80 bpm at rest) offered no clinical benefit over lenient control in patients with preserved LV function and acceptable symptoms. Strict control remains reserved for patients who remain symptomatic or develop tachycardiomyopathy. A cutoff of 80 bpm reflects the older strict target, and 130 bpm exceeds any accepted control threshold.

Reference: ESC Guidelines for the Management of Atrial Fibrillation, 2020 ed.

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Written and medically reviewed by the StethoPrep medical team.