Recommendation 1 – Treatment of precipitating or reversible conditions (2010)
We recommend the optimal treatment of precipitating or reversible predisposing conditions of AF prior to attempts to restore or maintain sinus rhythm (Strong Recommendation, Low Quality Evidence).

Recommendation 2 – Rhythm control strategy for patients symptomatic on rate control therapy (2010)
We recommend a rhythm-control strategy for patients with AF or AFL who remain symptomatic with rate-control therapy or in whom rate-control therapy is unlikely to control symptoms (Strong Recommendation, Moderate Quality Evidence).

Recommendation 3 – Goal of rhythm control therapy (2010)
We recommend that the goal of rhythm-control therapy should be improvement in patient symptoms and clinical outcomes, and not necessarily the elimination of all AF (Strong Recommendation, Moderate Quality Evidence).

Values and preferences (2010)
Recommendations 1-3 place a high value on the decision of individual patients to balance relief of symptoms and improvement in QOL and other clinical outcomes with the potentially greater adverse effects of the addition of class I or class III antiarrhythmic drugs to rate-control therapy.

Recommendation 4 – Maintenance antiarrhythmic drugs first-line in patients with recurrent AF (2010)
We recommend use of maintenance oral antiarrhythmic therapy as first-line therapy for patients with recurrent AF in whom long-term rhythm control is desired (see Figures) (Strong Recommendation, Moderate Quality Evidence).

Recommendation 5 –Avoid antiarrhythmic in patients with advanced sinus or AV node disease (2010)
We recommend that oral antiarrhythmic drug therapy should be avoided in patients with AF or AFL and advanced sinus or AV nodal disease unless the patient has a pacemaker or implantable defibrillator (Strong Recommendation, Low Quality Evidence).

Recommendation 6 – AV blocking agent to be used along with a class I antiarrhythmic drug (2010)
We recommend that an AV blocking agent should be used in patients with AF or AFL being treated with a class I antiarrhythmic drug (eg, propafenone or flecainide) in the absence of advanced AV node disease (Strong Recommendation, Low Quality Evidence).

Values and preferences (2010)
Recommendations 4 to 6 place a high value on the decision of individual patients to balance relief of symptoms and improvement in QOL and other clinical outcomes with the potentially greater adverse effects of class I and class III antiarrhythmic drugs compared with rate-control therapy.

Recommendation 7 – ‘Pill in the pocket’ therapy in patients with infrequent AF (2010)
We recommend intermittent antiarrhythmic drug therapy (“pill in the pocket”) in symptomatic patients with infrequent, longer-lasting episodes of AF or AFL as an alternative to daily antiarrhythmic therapy (Strong Recommendation, Moderate Quality Evidence).

Values and preferences (2010)
This recommendation places a high value on the results of clinical studies demonstrating the efficacy and safety of intermittent antiarrhythmic drug therapy in selected patients.

Recommendation 8 – Electrical or pharmacological cardioversion for sinus rhythm restoration (2010)
We recommend electrical or pharmacologic cardioversion for restoration of sinus rhythm in patients with AF or AFL who are selected for rhythm-control therapy and are unlikely to convert spontaneously (Strong Recommendation, Low Quality Evidence).

Recommendation 9 – Pre-treatment with antiarrhythmic drugs before electrical cardioversion (2010)
We recommend pre-treatment with antiarrhythmic drugs prior to electrical cardioversion in patients who have had AF recurrence post cardioversion without antiarrhythmic drug pre-treatment (Strong Recommendation, Moderate Quality Evidence).

Values and preferences (2010)
Recommendations 8 and 9 place a high value on the decision of individual patients to pursue a rhythm-control strategy for improvement in QOL and functional capacity.

Recommendation 10 – For symptomatic bradycardia, dual-chamber pacing (2010)
We suggest that patients requiring pacing for the treatment of symptomatic bradycardia secondary to sinus node dysfunction, atrial or dual-chamber pacing be generally used for the prevention of AF (Conditional Recommendation, High Quality Evidence).

Recommendation 11 – Pacemaker to be programmed to minimize ventricular pacing (2010)
We suggest that, in patients with intact AV conduction, pacemakers be programmed to minimize ventricular pacing for prevention of AF (Conditional Recommendation, Moderate Quality Evidence).

Values and preferences (2010)
Recommendations 10 and 11 recognize a potential benefit of atrial or dual-chamber pacing programmed to minimize ventricular pacing to reduce the probability of AF development following pacemaker implantation.