Atrial fibrillation(AF) is the most common arrhythmia requiring the attention of internists and cardiologists.
Patients with AF have higher rates of morbidity and death than similar patients with normal sinus rhythm. ....

Patients with AF have a slew of comorbidities, including hypertensive and ischemic heart disease. ...
The main concerns are the risk of stroke and
the symptoms of heart failure and fatigue often with exercise intolerance.

Information from registries of patients with AF
has permitted the development of
prognosticators of stroke risk.
The CHADS2 score(congestive heart failure, hypertension, age >75, diabetes,
and prior stroke or transient ischemic attack)
is an amazingly simple way to identify patients
with AF who are at highest risk of stroke.
This in turn has allowed stratification of patients for entrance into various anticoagulation studies.

And perhaps surprisingly, when many factors are considered, nothing turns out to be
dramatically better than warfarin(Coumadin) --
if the INR(international normalized ratio,
Prothrombin time) can be appropriately
controlled. ...

Chronic or intermittent AF is not readily prevented in most patients, and many symptomatic patients may benefit from drug therapy or radiofrequency ablation.

Studies suggest that trying to convert AF to normal sinus rhythm versus controlling the ventricular rate
may not be worth the effort and the risk
in many patients with AF. .........

Despite many large, well-done studies comparing antiarrhythmic drugs, ablation and anticoagulants, patients will still benefit most from an experienced
clinician's reflective, individualized assessment
before embarking on algorithm-driven
long-term therapy. ....

.... An excerpt from the editorial, Clevenland Clinic Journal of Medicine,
     August, 2012