Also, if possible, sinus rhythm should be preserved. Atrial contributions to stroke volume may be elevated in MS patients who are in the early stages of the disease and who are not in atrial fibrillation. Once atrial fibrillation has occurred, the atrial kick is lost. In this case, however, the most important factor in the deterioration of the patient’s clinical condition is tachycardia itself, rather than loss of the atrial kick. In any event, digoxin should be continued perioperatively. Short-acting β-blockers can then be used for heart rate control.