See NICE's information on prescribing medicines. 1.7.6 Do not offer amiodarone for long-term rate control. [2021] For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on rate control. Full details of the evidence and the committee's discussion are in evidence review I: non-ablative rate control therapies. Rhythm control 1.7.7 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. Antiarrhythmic drug therapy 1.7.8 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. [2014] 1.7.9 Do not offer class 1c antiarrhythmic drugs such as flecainide or propafenone to people with known ischaemic or structural heart disease. 1.7.10 If drug treatment for long-term rhythm control is needed, consider a standard beta-blocker (that is, a beta-blocker other than sotalol) as first-line treatment unless there are contraindications. [2014] 1.7.11 If beta-blockers are contraindicated or unsuccessful, assess the suitability of alternative drugs for rhythm control, taking comorbidities into account. [2014] 1.7.12 Follow the advice on dronedarone as a second-line treatment option for long-term rhythm control after successful cardioversion in NICE's technology appraisal guidance on dronedarone for the treatment of non- permanent atrial fibrillation. [2014] 1.7.13 Consider amiodarone for people with left ventricular impairment or heart 1.7.14 In people with infrequent paroxysms and few symptoms, or if symptoms are induced by known precipitants (such as alcohol, caffeine), a 'no drug treatment' strategy or a 'pill-in-the-pocket' strategy (in which antiarrhythmic drugs are taken only when an episode starts) should be considered and discussed with the person. 