We recommend that hemodynamically stable patients with AF/AFL of &ge;48 hours’ or uncertain duration for whom a strategy of rhythm control has been selected should have rate control optimized and receive therapeutic oral anticoagulants (OAC) therapy (warfarin [INR 2-3] or dabigatran) for 3 weeks before and at least 4 weeks postcardioversion.<br /><br /><b>Following attempted cardioversion:</b> If AF/AFL persists or recurs or if symptoms suggest that the presenting AF/AFL has been recurrent, the patient should have antithrombotic therapy continued indefinitely (using either OAC or aspirin as appropriate).<br/><br/>If sinus rhythm is achieved and sustained for 4 weeks, the need for ongoing antithrombotic therapy should be determined based on the risk of stroke, and in selected cases, expert consultation may be required. (Recommendation Strong, Quality Moderate)<br /><br /><b>Values and preferences: </b> These recommendations place a high value on minimizing stroke risk by rate control, appropriate anticoagulation and delayed cardioversion, and a lower value on symptomatic improvement associated with immediate cardioversion