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This is a pharmacological combination regimen consisting of a beta blocker, digoxin, and amiodarone, used for heart rate control in patients with permanent atrial fibrillation. It was utilized as a comparator arm in the SPARE III (NCT01181414) Phase 4 clinical trial conducted by the Hospital Clinic of Barcelona. The regimen targets the atrioventricular (AV) node through multiple mechanisms: beta blockers antagonize adrenergic receptors, digoxin inhibits the Na+/K+-ATPase pump to slow AV nodal conduction via vagal effects, and amiodarone acts as a class III antiarrhythmic with multi-channel blocking properties. This combination is typically reserved for refractory cases where single or dual-agent therapy fails to achieve adequate rate control.
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