We recommend beta-blockers or nondihydropyridine calcium channel blockers as initial therapy for rate control of AF or AFL in most patients without a past history of myocardial infarction or left ventricular dysfunction. (Recommendation Strong, Quality Moderate)<br /><br />We suggest that digoxin not be used as initial therapy for active patients and be reserved for rate control in patients who are sedentary or who have left ventricular systolic dysfunction. (Recommendation Conditional, Quality Moderate)<br /><br />We suggest that digoxin be added to therapy with beta- blockers or calcium channel blockers in patients whose heart rate remains uncontrolled.<b>Values and preferences:  (Recommendation Conditional, Quality Moderate)<br /><br />We suggest that dronedarone may be added for additional rate control in patients with uncontrolled ventricular rates despite therapy with beta-blockers, calcium channel blockers, or digoxin. (Recommendation Conditional, Quality Moderate)<br /><br />We suggest that amiodarone for rate control should be reserved for exceptional cases in which other means are not feasible or are insufficient. (Recommendation Conditional, Quality Low)<br /><br /></b>These recommendations recognize that selection of rate-control therapy needs to be individualized on the basis of the presence or absence of underlying structural heart disease, the activity level of the patient, and other individual considerations.