Q: Which is the most effective therapy?
A: The most important concept to consider is that the efficacy of the therapy depends on the cardiac co-morbidities. For example therapy is more effective for atrial fibrillation occurring in the structurally normal heart than for one occurring in patients with valvular heart disease and with enlarged atria diameter. Therefore treating the cause of atrial fibrillation is at least as important as treating the arrhythmia. Neither drugs nor ablation are completely effective and the possibility of recurrent atrial fibrillation is between 40% and 50%. Ablation technique has made remarkable advancements in the last few years. However for several patients rate control strategy is the only feasible option. In such instances the correct use of drugs to optimize the cardiac rate (at rest and during exercise) and the administration of anticoagulants is extremely important to improve the patient’s quality of life.