What is the primary challenge regarding the treatment of atrial fibrillation when it is prolonged?

The primary challenge regarding the treatment of atrial fibrillation when it is prolonged is the structural heart changes that can occur. Prolonged atrial fibrillation can lead to significant alterations in the heart's anatomy and function, including atrial dilation and fibrosis. These structural changes can contribute to a cycle of persistent atrial fibrillation, making it more difficult to restore normal rhythm and increasing the likelihood of future episodes.

Addressing these structural changes is crucial because they may not only diminish the effectiveness of rhythm control strategies but also contribute to the worsening of the patient’s overall cardiac health. This understanding emphasizes the need for early intervention and management of atrial fibrillation to prevent such complications from developing over time.