The committee noted that although the most common side effects were less severe, the occurrence of severe side effects was unpredictable and long-term rate control with amiodarone should be avoided. Amiodarone should only be used as an interim therapy, for example while waiting for cardioversion, and would not usually be taken for longer than 12 months. How the recommendations might affect practice The recommendations reflect current practice. Digoxin monotherapy may now be an option in non-paroxysmal atrial fibrillation if comorbidities or patient preferences limit other rate-control drug choices. However, the committee agreed that this already happens in practice. Return to recommendations Left atrial ablation Why the committee made the recommendations Ablation may be a treatment option if antiarrhythmic drug treatment has not been successful or is not tolerated. The committee reviewed new clinical and health economic evidence for the different types of ablation for people with paroxysmal atrial fibrillation and agreed that the catheter ablation techniques were the most clinically effective ablation options. Thoracoscopy and the hybrid techniques led to lower recurrence, but they also led to more serious adverse effects. There were no clear differences in efficacy between the 4 catheter ablation techniques: radiofrequency point-by-point, radiofrequency multi-electrode, laser and cryoballoon ablation. A new economic model was developed for the guideline using the clinical evidence from people with paroxysmal atrial fibrillation. It showed that radiofrequency point-by-point ablation was more cost effective over a lifetime than antiarrhythmic drug treatment and other ablation strategies in people for whom 1 or more antiarrhythmic drug has failed. Cryoballoon, radiofrequency multi-electrode and laser ablation were the second, third and fourth most cost-effective options respectively. The committee acknowledged that the NHS reference cost used for the catheter ablation procedures may not fully capture differences in resource use between the different techniques. 