For patients at high risk of stroke with cardioversion (not receiving therapeutic OAC therapy for ≥3 weeks with any of the following: AF episode duration not clearly <48 hours; stroke or TIA within 6 months; rheumatic heart disease; mechanical valve), we recommend optimized rate-control and therapeutic OAC for 3 weeks before and at least 4 weeks after cardioversion. (Strong Recommendation, Moderate Quality Evidence)

Practical Tip: When OAC-therapy is indicated, a NOAC is preferred over warfarin for most patients.

Practical Tip: Prior to discharge, patients should have their resting heart rate reduced to <100 beats/minute and their walking heart rate to <110 beats/minute.

Practical Tip: Patients should receive both OAC-therapy and appropriate oral ratecontrolling agents (beta-blocker or non-dihydropyridine calcium-channel blocker)