This was previously discussed in this thread: [
www.afibbers.org]
My comment in the thread:
My recollection of AFFIRM that Gupta mentions (I read many years ago and did not reread), is that it was based on "intention to treat." That is rate vs. rhythm control. So on the rhythm control arm, people were given rhythm meds, but they weren't necessarily in NSR, just given the meds. In other words, just because someone was in the rhythm control arm, it doesn't mean they were actually in rhythm.
That being said, my strategy for nearly 17 years has been to minimize my time in afib as well as controlling all the controllable factors (with lifestyle, not meds) in CHA2DS2-VASc, such as hypertension, T2 diabetes (or its precursor of metabolic dysfunction). Also keeping NT-proBNP (as Dr. Gupta mentions) low. My values in 2020 were 32 & 41 pg/mL with < 253 being good per Cleveland Heart Lab.
