[Does every case of atrial fibrillation need to be treated?]

There is a risk of atrial fibrillation for 1 in 4 adults over the age of 40 years. In most cases the cause of atrial fibrillation is an underlying organic disease. Approximately 2.5 million mostly elderly male patients in Europe are affected by this dysrhythmia and it is expected that the number of patients will more than double by the year 2050. With a few exceptions every form of fibrillation should be treated regarding the underlying disease, the risk of thrombo-embolization and the arrhythmogenic symptoms. However, it must be questioned whether every case of atrial fibrillation must be anti-arrhythmically treated or in which cases rate control of ventricle function is adequate or whether rhythm control, i.e. conversion into sinus rhythm, is necessary. Arguments for conversion into a sinus rhythm are improved cardiac output, decreased risk of thrombo-embolization and hypercoagulability as well as a reduction of tachycardiomyopathies. A decline in clinical symptoms leads to improvement in the quality of life and also in many cases brain function.