This rhythm seems to provide countless nuanced discussions. The rhythm itself often brings a patient to medical attention, but the real concern is the stroke risk.
At this point, our way of risk assessing the likelihood of stoke is the CHADS or CHADS2 score. Ultimately, this is just a tool that says being old, having or being treated for hypertension, having diabetes, having congestive heart failure or previously having a stroke or TIA make it more likely to have a stroke. Saying it that way makes it sound so common sense. It also is interesting in what it doesn’t say.
There is nothing that says the amount atrial fibrillation is predictive of who will have a stroke. That is not so intuitive. It would seem that the greater the burden of atrial fibrillation that the stroke risk should be higher, but it is at best a weak predictor
This leads to a dilemma, the patient is complaining of a rhythm problem, and the important part of the treatment never addresses the symptom the patient is having. It is not all that surprising that neither of us feel like we have communicated our concerns at the end of an appointment that is now often less than 8 minutes.