[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. [2006] 1.7.15 In people with paroxysmal atrial fibrillation, a 'pill-in-the-pocket' strategy should be considered for those who: have no history of left ventricular dysfunction, or valvular or ischaemic heart disease and have a history of infrequent symptomatic episodes of paroxysmal atrial fibrillation and have a systolic blood pressure greater than 100 mmHg and a resting heart rate above 70 bpm and are able to understand how to, and when to, take the medication. [2006] Cardioversion 1.7.16 For people having cardioversion for atrial fibrillation that has persisted for longer than 48 hours, offer electrical (rather than pharmacological) 1.7.17 Consider amiodarone therapy starting 4 weeks before and continuing for up to 12 months after electrical cardioversion to maintain sinus rhythm, and discuss the benefits and risks of amiodarone with the person. [2014] 1.7.18 For people with atrial fibrillation of greater than 48 hours' duration, in whom elective cardioversion is indicated: both transoesophageal echocardiography (TOE)-guided cardioversion and conventional cardioversion should be considered equally effective a TOE-guided cardioversion strategy should be considered: if experienced staff and appropriate facilities are available and if a minimal period of precardioversion anticoagulation is indicated due to the person's choice or bleeding risks. [2006] Left atrial ablation 1.7.19 If drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic paroxysmal or persistent atrial fibrillation: consider radiofrequency point-by-point ablation or if radiofrequency point-by-point ablation is assessed as being unsuitable, consider cryoballoon ablation or laser balloon ablation. 