98 hythmic medication before repeating electrical CV in patients with AF recurrence (Evidence Level C). 5.2 Maintenance of sinus rhythm Class I: (1) Antiarrhythmic drugs to maintain sinus rhythm should not be used in AF patients without risk factors for recurrence and whose triggering factor has been corrected (Evidence Level C); (2) Potentially removable AF causes should be identified and treated before starting the antiarrhythmic treatment (Evidence Level C). Class II A: (1) Pharmacological therapy to maintain sinus rhythm and prevent tachycardiomiopathy (Evidence Level C); (2) Antiarrhythmic therapy to treat infrequent and well tolerated AF recurrences (Evidence Level C); (3) Outpatient antiarrhythmic therapy for AF patients without heart disease and with good tolerance to the drug used (Evidence Level C); (4) Outpatient propafenone for idiopathic paroxysmal AF patients without heart disease and in sinus rhythm at beginning of treatment (Evidence Level B); (5) Outpatient sotalol in patients with mild or no heart disease, when in sinus rhythm and at risk of paroxysmal AF, if corrected QT interval is lower than 460 ms, plasma electrolytes are normal and in the absence of risk factors for pro-arrhythmic effects (Evidence Level C); and (6) Catheter ablation as alternative to pharmacological therapy to prevent AF recurrences, in symptomatic patients with little or no left atrial overload (Evidence Level C). 5.3 Heart rate control in AF Class I: (1) Betablockers or non-dihydropiridinic calcium channel blockers (veparamil and diltiazem) in individualized doses for patients without significant structural heart disease, with persistent or permanent AF (Evidence Level B); (2) In the absence of pre-excitation, intravenous administration of betablocker (esmolol, metropolol or propranolol) or non- dihydropiridinic calcium channel blockers (verapamil and diltiazem) to decrease ventricular response in acute AF, with special attention to patients with hypotension or HF (Evidence Level B); (3) Intravenous administration of digi- talis or amiodarone to control HR in patients with AF and HF, in the absence of pre-excitation (Evidence Level B); (4) In patients with effort-related AF symptoms, treatment efficacy should be tested during exercises, adjusting drugs in a sufficient dose to maintain HR in physiological levels (Evidence Level C); (5) Digoxin to control heart rate at rest in AF patients with ventricular dysfunction and in sedentary individuals (Evidence Level C). Class II A: (1) Combination of digoxin and betablockers or non-dihydropiridinic calcium channel blockers to control heart rate at rest and during exercise in AF patients. Drug Franken RA et al. Atrial fibrillation in the elderly choice should be individualized and controlled to prevent bradycardia (Evidence Level B). (2) Heart rate control with AV node ablation with implant of permanent pacemaker when pharmacological therapy is not sufficient or is associated to side effects, or in the presence or suspicion of tachycardia- miopathy (Evidence Level B). (3) Intravenous amiodarone to control heart rate in AF patients when other drugs fail or are contraindicated (Evidence Level C). Class III: (1) Digitalic drugs used as isolated agents to control ventricular response in paroxysmal AF patients (Evidence Level B); (2) Catheter ablation of atrioventricular node without previous drug treatment to control heart rate in AF patients (Evidence Level C); (3) Non-dihydropiridinic calcium channel blockers for patients with decompensated HF (Evidence Level C); and (4) Administration of digitalic or non-dihydro- piridinic calcium channel blockers for patients with AF and pre-excitation syndrome (Evidence Level C). References 1 2 3 4 5 6 7 8 9 10 Flegel KM. From delirium cordis to atrial fibrillation: historical development of a disease concept. Ann Intern Med 1995; 122: 867–873. Sabeh MK, MacRae CA. The genetics of atrial fibrillation. Curr Opin Cardiol 2010, 25: 186–191. Falk RH. Atrial fibrillation. N Engl J Med 2001; 344: 1067–1078. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in Adults JAMA 2001; 285: 2370–2375. Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994; 271: 840–844. Iguchi Y, Kimura K, Shibazaki K, et al. Annual incidence of atrial fibrillation and related factors in adults. Am J Cardiol 2010; 106: 1129–1133. Fuster V, Rydén LE, Cannon DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibri- llation. A Report of the American College of Cardiology/Amer- ican Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006; 48: 854–906. Diretriz de Fibrilação Atrial da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2003; 81 (Supl VI): S1–S24. Fuster A, Rydén LE, Asinger RW, et al. 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