Unfortunately, there is no generally accepted "best" approach to treating atrial fibrillation. Because it has many causes (and sometimes no clear cause), it is a difficult arrhythmia to treat. Also, all the current treatments involve at least some risk to the patient. What this boils down to: The treatment of atrial fibrillation can be controversial, and may vary from doctor to doctor, and patient to patient.
For patients with paroxysmal atrial fibrillation (i.e., those who have episodes of the arrhythmia, but usually are in a normal rhythm) treatment is not so controversial. These patients should be restored to a normal rhythm as quickly as possible, and certainly within 24-36 hours to reduce the risk of clots from atrial fibrillation.
More Challenging to Treat: Chronic AF
It is in the patients with chronic or persistent atrial fibrillation that the controversy arises. The chief questions: Should attempts be made to restore and maintain a normal heart rhythm in these patients, or should the doctor allow the patient to remain in atrial fibrillation and take steps to control the resulting heart rate?The mere fact that this is a question reveals something about our ability to "get rid of" atrial fibrillation - it turns out that this can be quite difficult to accomplish, and attempts to accomplish it can produce significant complications. So in patients with chronic or persistent atrial fibrillation, the first issue that must be resolved is how aggressive to be in trying to get the heart rhythm back to normal.
Understanding the different treatment options, and when they are most appropriate, is vitally important for doctors, of course. But such an understanding is just as important for patients (who, these days, are always being rushed into medical decision in order to reduce waste, optimize efficiency, minimize length of stay, achieve the most benefit for the health care dollar, etc., etc). These decisions should be made with everyone's participation and understanding - the doctor as well as the patient.
In-Depth Information on Treating AF
The following links discuss the controversy of normal rhythm vs. rate control in patients with atrial fibrillation, and then summarize the current state-of-the-art treatments for the patient with atrial fibrillation.Restoring and Maintaining a Normal Heart Rhythm
Letting Atrial Fibrillation Persist While Managing Symptoms
The Bottom Line: Where Does this Leave the Patient with Atrial Fibrillation?
