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Current guidelines recommend either a beta-blocker or a calcium-channel blocker as first-line rate-control treatment for atrial fibrillation (AF). However, head-to-head trials of the agents in current use are lacking. To compare the effects of four once-daily drug regimens on heart rate and AF-related symptoms in patients with permanent, rapidly conducted AF, investigators in Norway conducted a prospective, randomized, investigator-blind, crossover study. Sixty adults (mean age, 71; 18 women) with permanent AF and without congestive heart failure or ischemic heart disease received, in randomized order, diltiazem, 360 mg; verapamil, 240 mg; metoprolol, 100 mg; and carvedilol, 25 mg. Each drug was given for 3 weeks to ensure steady-state plas…