All of the available beta-blocking drugs can be used safely with the exception of sotalol. This drug must not be used in the management of permanent (chronic) atrial fibrillation because it carries a risk of torsades de pointes. Other beta-blockers do not have this adverse side effect.
A recent clinical trial confirmed that it is safer to manage patients with permanent atrial fibrillation by controlling their ventricular rate (heart rate) rather then attempting to cardiovert to sinus rhythm or use pharmacologic agents to maintain sinus rhythm. Patients after conversion do not often remain in sinus rhythm and pharmacologic agents (amiodarone, flecainide, propafenone, sotalol, and quini-dine) necessary to maintain sinus rhythm are usually not successful and produce life-threatening adverse effects.

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