You can take up to 400 mg/diem of metoprolol if you are in heart failure. Those with AF are normally topped out at 200 mg, but my own EP in Canada said you might need up to 300 for AF. At that point, a mechanical intervention is definitely indicated. IOW, a catheter ablation. When drugs don't work (anymore). what's left?

AF won't kill you. Many live for decades with it. However, you are highly unlikely to live long with the AF allowed to go untreated....which is the key. It must be managed. If left unchecked, it progresses almost universally across patients, and it becomes more and more untreatable, often leading to heart failure...which will kill you.

My own EP performed an ablation and sent me home with instructions. A week later, I was in the local ER and I never did get through the 'blanking period' of eight weeks Scott-free. In fact, he later took as evidence that his original effort had failed from my Galaxy watch. His outreach nurse, when she listened to me, asked if I could send her a graphic depiction of the ECG my watch had recorded when I knew I was again in AF, now 14 weeks out from the ablation. As soon as he looked at what my Galaxy watch recorded, he immediately saw that it was AF (no discernible P waves, and the R-R intervals were unevenly spaced). He called me himself and we agreed he should take another stab at me...so to speak.

As far as I know, those who have the latest smart watches ought to have accompanying apps on their phones that manage the watch's functions. They all, I'm pretty sure, record AF when the wearer makes the effort to run the ECG applet. This record is held on the phone's side, and you can look at it. It should...SHOULD... show a proper twin-lead ECG with the squiggles on the graph paper depiction. My Galaxy does, at least. Twin lead because I must place the tip of a finger against the 'back' button when recording an ECG.

My posts are long...sorry. One other, and last, bit of exceedingly important information. Over at apneaboard.com, we see people all the time with the absolutely wrong machines delivering the wrong therapy. Every day, five or more people who were misdiagnosed, given the wrong prescription, or given a machine that can't properly splint them so that they can rest and sleep well. One common problem is that people don't necessarily only have obstructive apnea. They may have, or may develop, 'complex' sleep apnea where central apnea is the main culprit. Most bipap machines are incapable of properly treating complex apnea or fully central apnea. In those cases, the patient needs what is called an ASV, an adaptive servo-ventilator. The insurers won't like having to pay through the nose for those costly machines, but if that's all that will work..!! Also, the prescribing individual will often duly try to work you through elevated levels of PAP therapy, and it may take months until they see, or admit, that a bipap machine simply isn't up to the job. They also figure whatever the patient can afford, or whatever their insurer will support, is probably better than nothing. Often, they're amazingly right, but just as often they're plain wrong. Without proper sleep and rest...and recovery...you can count on continued, and almost certainly progressive, atrial fibrillation if sleep apnea was the progenitor.