Patients ≥ 18 years of age with paroxysmal or persistent AF who have an implantable cardiac monitor (either loop recorder or pacemaker) and who are receiving daily beta-blocker therapy will be screened for meeting the inclusion/exclusion criteria.
Trial participants will then be randomized into the daily beta-blocker or as-needed pharmacological rate control.
At baseline and six months trial participants will undergo assessment of the following measures:
Assessment of Quality of life using the Minnesota Living with Heart Failure Questionnaire and the Atrial Fibrillation Effect on Quality of life Questionnaire.
Cardiopulmonary exercise test, 6 Minute Walk Test and average daily activity level via integrated accelerometer of the implantable cardiac monitor (if available).
Assessment of AF burden
Study participants may opt into long-term follow up visits at 12, 18 and 24 months.
Chart review will continue for up to 4 years after enrollment for the purpose of monitoring clinical endpoints:
Heart failure events (diuretic drug change, emergency room visit, hospitalization)
AF events (hospitalization, emergency room visit, cardioversion, antiarrhythmic medication initiation)
Stroke or transient ischemic attack
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