Full details of the evidence and the committee's discussion are in evidence review K: antiarrhythmic drugs after ablation. Pace and ablate strategy 1.7.24 Consider pacing and atrioventricular node ablation for people with permanent atrial fibrillation with symptoms or left ventricular dysfunction thought to be caused by high ventricular rates. [2014] 1.7.25 When considering pacing and atrioventricular node ablation, reassess symptoms and the consequent need for ablation after pacing has been carried out and drug treatment further optimised. [2014] 1.7.26 Consider left atrial catheter ablation before pacing and atrioventricular node ablation for people with paroxysmal atrial fibrillation or heart failure caused by non-permanent (paroxysmal or persistent) atrial fibrillation. 1.8 Management for people presenting acutely with atrial fibrillation Rate and rhythm control for people presenting acutely 1.8.1 Carry out emergency electrical cardioversion, without delaying to achieve anticoagulation, in people with life-threatening haemodynamic instability caused by new-onset atrial fibrillation. [2014] 1.8.2 In people with atrial fibrillation presenting acutely without life-threatening haemodynamic instability: offer either rate or rhythm control if the onset of the arrhythmia is less than offer rate control if onset is more than 48 hours or is uncertain. [2014] 1.8.3 In people with atrial fibrillation presenting acutely with suspected concomitant acute decompensated heart failure, seek senior specialist input on the use of beta-blockers and do not use calcium-channel 1.8.4 Consider either pharmacological or electrical cardioversion depending on clinical circumstances and resources in people with new-onset atrial fibrillation who will be treated with a rhythm-control strategy. [2014] 1.8.5 If pharmacological cardioversion has been agreed on clinical and resource grounds for new-onset atrial fibrillation, offer: a choice of flecainide or amiodarone to people with no evidence of structural or ischaemic heart disease or amiodarone to people with evidence of structural heart disease. 