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. (Recommendation Strong, Quality Moderate)<br /><br />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. (Recommendation Strong, Quality Low)<br /><br />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. (Recommendation Strong, Quality Low)<br /><br /><b>Values and preferences: </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 class I and class III antiarrhythmic drugs compared with rate-control therapy.