How should I approach rhythm control in a patient with atrial fibrillation who is symptomatic despite rate control?

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 ¹.

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 ¹.

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 ¹.

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 ¹.

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 ¹.