Are you regarding anti-nodal blocking agents, such as Dilitazem, and beta blockers, such as Metoprolol, as antiarrhythmic therapy? If these drugs were used as a first line of treatment (SOC) in the ER, would those patients be necessarily excluded from the study?

CHANGE AFIB is comparing the initiation of early rhythm control versus usual care. Specifically, patients are randomized to DRONEDARONE + USUAL CARE versus USUAL CARE ALONE. As a result, it is expected that many patients will be on atrioventricular nodal blocking agents in both arms, including beta-blockers and calcium channel blockers. Patients treated with beta-blockers, CCBs, or digoxin are eligible. Digoxin should be discontinued in those randomized to dronedarone. Throughout the course of the trial, patients may experience progression of their AF and their physician may conclude that antiarrhythmic drug therapy is required. This could include initiation of rhythm control in the usual care arm or transition to a new rhythm control therapy in the dronedarone arm.