Management of atrial fibrillation has been a big puzzle for cardiologists for many decades till it became a corporate game , and now in the era of recession it has become medicare’s night mare !
So , we were made to dance to the tunes of the so called evidence based cardiology . . .
- From only rhythm control to . . . in 1990s
- Either rhythm or rate control . . . in early late 1990s
- Then cost control was found more important than rate control . . .
- . . . So rate control became superior to rhythm control in early 2000s
In 2010 , even the rate control became a luxury , here comes the real ace ! ” Casual rate control may be suffice in most cases of AF “
Read this article from NEJM , which tries to make sense out of nonsense and judge for yourself
Probably the most influential article in electrophysiology over the next decade
Click below to reach Nejm article
http://content.nejm.org/cgi/content/full/NEJMoa1001337?query=TOC
http://content.nejm.org/cgi/content/full/NEJMe1002301?query=TOC
Gist of the trial
Technically and literally it means a “Take it easy attitude” as long as patient is comfortable , even a rate of more than 100 is allowed . Few years back the above concept could be termed a “non sense”
Final message
In this perennial management issue of AF , Whether , we were successful in restoring sinus rhythm or not , we have restored the common sense* Thanks to RACE 2 investigators.
* Do not unnecessarily trouble a asymptomatic patient with those powerful and costly antiarrhythmic drugs .
Dr.S.Venkatesan MD 
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