{'fraction_non_alphanumeric': 0.03816793893129771, 'fraction_numerical': 0.0, 'mean_word_length': 5.554545454545455, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Clinical inquiries. Other than anticoagulation, what is the best therapy for those with atrial fibrillation?

■ EVIDENCE-BASED ANSWER Rate control with long-term anticoagulation is recommended for most patients with atrial fibrillation (strength of recommendation [SOR]: A, based on randomized controlled trials [RCTs]). A rhythmcontrol strategy provides no survival or quality-oflife benefit when compared with rate control and causes more adverse drug effects and increased hospitalizations (SOR: A, based on RCTs). Non-dihydropyridine calcium-channel blockers (diltiazem, verapamil) and most beta-blockers are effective for controlling heart rate both at rest and during exercise (SOR: A, based on RCTs). Digoxin is only effective for rate control at rest and should be reserved for patients with systolic dysfunction or as an adjunct for those inadequately ratecontrolled on calcium-channel blockers or betablockers (SOR: B, based on RCTs). Subgroups in whom rhythm control may be superior are patients with persistent fatigue and dyspnea despite ventricular rate control and those unable to achieve adequate rate control. Both pharmacologic conversion (SOR: B, based on RCTs) and direct-current cardioversion (SOR: B, based on observational studies) are appropriate options in these patients. Long-term anticoagulation is necessary for highrisk patients even if they are successfully managed with rhythm control (SOR: A, based on RCTs).