By vgreene, 10 August, 2015 Cath ablation6 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, 10 August, 2015 Cath ablation6 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, 10 August, 2015 Restore sinus rhythm1 via DC cardioversion, antiarrhythmic drug, or RF cath ablation; +/- rate control. Correct underlying causes [I/C]
By vgreene, 10 August, 2015 Postconversion maintenance drug options5 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, 10 August, 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
By vgreene, 10 August, 2015 Pharmacologic cardioversion5 + peri-procedural anticoagulation4 + rate-control tx: Flecainide, dofetilide, propafenone, IV ibutilide [I/A] or amiodarone5 [IIa/A]
By vgreene, 10 August, 2015 DC cardiovert [I/B] + peri-procedural anticoagulation.4 Repeat/serial attempts based on sinus rhythm duration, sx, pt preference4 +/- rate-control tx [IIa/C]
By vgreene, 10 August, 2015 Consider antithrombotic options2,3 [IIb/C] based on stroke/bleed risks, renal fxn, pt preference [I/C]