Rhythm control may be preferred in selected symptomatic patients using electrical cardioversion, antiarrhythmic drugs or radiofrequency ablation for failed antiarrhythmic drug therapy.
In symptomatic atrial fibrillation, elective electrical cardioversion with or without additional antiarrhythmic drugs (to enhance success) combined with adequate anticoagulation, if not contraindicated (international normalised ratio of 2 to 3 for at least 4 weeks prior and 4 weeks after cardioversion) could be considered, but maintenance of sinus rhythm is unpredictable.