In a US claims analysis of 1.7 million patients hospitalized for surgery, perioperative AF was associated with an increased long-term risk of ischemic stroke, 1172 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] especially following noncardiac surgery.306 It is not known to what extent the risk was mediated by AF recurrence (often asymptomatic) or was independent of rhythm. Thus, patients should be anticoagulated according to their thromboembolic risk pro le based on CHA2DS2-VASc, regardless of whether sinus rhythm has been restored via ablation, cardioversion, or other means. Recommendations 32. In patients with AF in whom catheter ablation of AF or implantation of cardiac electronic implantable devices is planned, we suggest performing the procedure on uninterrupted VKA (within the INR therapeutic range), dabigatran or rivaroxaban (Weak recommendation, low quality evidence). 33. In patients in whom sinus rhythm has been restored, we suggest that long-term anticoagulation should be based on the patient s CHA2DS2-VASc thromboembolic risk pro le, regardless of whether sinus rhythm has been restored via ablation, cardioversion (even spontaneous), or other means (Weak recommendation, low quality evidence). Cerebrovascular Disease AF Patients Presenting With an Acute Ischemic Stroke or TIA: In AF-associated acute ischemic stroke, the risk of early recurrence is high: for example, the International Stroke Trial reported a 4.8% risk of recurrent stroke in those with AF within the rst while other studies suggest a recurrence risk of between 0.4% and 1.3% per day in the rst 7 to AF-related ischemic strokes are more often disabling or fatal than other types, with longer hospital stays and higher costs,312 so preventing early recurrence is a key clinical challenge. The safety and bene t of OAC in acute stroke have not been established. 