Rate control vs Rhythm control

We would like to address a concern raised by a reader.

When you state that you opt for rate rather than rhythm control is this for all patients or do you take into account symptoms?
I have had patients who, despite being rate controlled, still felt fatigue, DOE and/or had reduced exercise capacity while in afib. And they did better once undergoing cardioversion.
Are any of the thrombin inhibitors available in Malaysia? We are getting ready to start a clinical trial on dabigatran. Curious if you have any clinical experience with this class of drugs.
Well, here's our take on it. Large scale clinical trials shows no difference between rate control and rhythm control, in terms of symptoms and strokes. I usually keep my patients HR at above 60/min, and give them warfarin till a PT-INR of above 1.5 - 2.0. Yes, when they exercise, there may be easy fatiguability.

Balanced against that, patients on rhythm control may require a few admissions to cardiovert. The ablation option is gaining popularity but I have not seen them compared in large scale clinical trials.

No, we do not have thrombin inhibitors in Malaysia. We have low molecular weight heparin and Glycoprotein 2b3a.