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Learning from clinical randomized trials individualized therapy is important in the management of atrial fibrillation.

trial fibrillation (AF) is the arrhythmia most commonly encountered in the clinical practice. Cardiologists usually have plenty experience with the management of AF, which has various etiologies and pathophysiology. Thus, the determination of treatment of AF is frequently made case-by-case, either by referring to practice guidelines or sometimes empirically. On the first visit of an AF patient to an outpatient clinic, we evaluate the patient’s status, including symptoms experienced during AF, type of AF (paroxysmal, persistent or permanent), clinical background, presence of any basic heart disease, degree of atrial remodeling, risk factors for thromboembolic events and other complications. Of the 2 representative therapeutic methods (ie, rhythm-control or rate-control), we decide which is the most appropriate for the patient. For younger generation, symptomatic patients with paroxysmal AF, the majority of cardiologists choose the rhythm-control strategy, where as for the asymptomatic elderly patient with persistent AF, they are likely to choose the rate-control strategy. Why do we make decisions like these? Because we know how the patient will respond to the specific treatment and how quality of life (QOL) will be improved according to which strategy is chosen.