By vgreene, 15 January, 2015 Cath ablation<sup>19</sup> for persistent AF w/ sx reasonable if refractory/intolerant to ≥1 class I/III drug [IIa/A], consider for long-standing (>12 mo) persistent AF w/ sx [IIb/B]; consider as initial strategy before class I/III drug trial [IIb/B]
By vgreene, 15 January, 2015 Cath ablation<sup>19</sup> for paroxysmal AF w/ sx: useful if refractory/intolerant to ≥1 class I/III drug [I/A]; reasonable as initial strategy before class I/III drug trial for recurrent paroxysmal AF w/ sx [IIa/B]
By vgreene, 15 January, 2015 Postconversion drug maintenance options<sup>19</sup> based on CAD/LVH/HF, comorbidities, drug risks [I/A], +/- rate-control tx. OK to continue antiarrhythmic despite infrequent well-tolerated recurrences [IIb/C]; stop if AF becomes permanent [III/B]
By vgreene, 15 January, 2015 Postconversion pill-in-pocket prn option: propafenone/flecainide + BB/non-DHP-CCB (diltiazem/verapamil), once proven safe in monitored setting, reasonable to terminate out-pt AF [IIa/B]
By vgreene, 15 January, 2015 Pharmacologic cardioversion<sup>18</sup> + peri-procedural anticoagulation<sup>17</sup> + rate-control tx: flecainide, dofetilide, propafenone, IV ibutilide [I/A] or amiodarone<sup>18</sup> [IIa/A]
By vgreene, 15 January, 2015 DC cardiovert [I/B] + peri-procedural anticoagulation.<sup>17</sup> Repeat/serial attempts<sup>17</sup> based on sinus rhythm duration, sx, pt preference<sup>17</sup> +/- rate-control tx [IIa/C]
By vgreene, 15 January, 2015 Restore sinus rhythm<sup>15</sup> via DC cardioversion, antiarrhythmic drug, or RF cath ablation; +/- rate control. No long-term antithrombotic tx (unless HCM).<sup>16</sup> Correct underlying causes [I/C].
By vgreene, 15 January, 2015 Control heart rate;<sup>5</sup> adjust to control rate during exertion [I/C]
By vgreene, 15 January, 2015 If drug rate control inadequate/sx persist, use rhythm control.<sup>9</sup> If drug tx inadequate and rhythm control not achievable: AV-node ablation<sup>9</sup> + pacing [IIa/B]
By vgreene, 15 January, 2015 If HF w/ rest/exercise HR not controlled w/ BB, CCB (in HFpEF) or dig (alone or combined): consider amiodarone<sup>8</sup> [IIb/C]