Consider pharmacological and/or electrical rhythm control for people with atrial fibrillation whose symptoms continue after heart rate has been controlled or for whom a rate‑control strategy has not been successful NICE NG196.
Assess the need for drug treatment for long‑term rhythm control, taking into account the person's preferences, associated comorbidities, risks of treatment and likelihood of recurrence of atrial fibrillation NICE NG196.
If drug treatment for long‑term rhythm control is needed, consider antiarrhythmic drugs such as amiodarone, especially in cases where other treatments are unsuitable or not tolerated NICE NG196.
Discuss the risks and benefits of antiarrhythmic drug therapy with the person, including options like radiofrequency ablation or cryoballoon ablation if drug treatment is unsuccessful or not tolerated NICE NG196.
Consider left atrial ablation if drug treatment is unsuccessful, unsuitable, or not tolerated, and discuss the risks, benefits, and the possibility that symptoms may not be long-lasting NICE NG196.