We recommend the optimal treatment of precipitating or reversible predisposing conditions of AF prior to attempts to restore or maintain sinus rhythm. (Recommendation Strong, Quality Low)<br /><br />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.<b>Values and preferences:  (Recommendation Strong, Quality Moderate)<br /><br />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. (Recommendation Strong, Quality Moderate)<br /><br /></b>These recommendations 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.