Algorithm for the treatment of AF and AFl Algorithm for the treatment of AF and AFl. aIf AF is less than 48 hours in duration, anticoagulation prior to cardioversion is unnecessary; initiate anticoagulation with unfractionated heparin, a low-molecular-weight heparin, apixaban, dabigatran, or rivaroxaban as soon as possible either before or after cardioversion for patients at high risk for stroke (this anticoagulant regimen or no antithrombotic therapy may be considered in low-risk patients). bAblation may be considered for patients who fail or do not tolerate at least 1 AAD or as first-line therapy (before AAD therapy) for select patients with recurrent symptomatic paroxysmal AF. cChronic antithrombotic therapy should be considered in all patients with AF and risk factors for stroke regardless of whether or not they remain in sinus rhythm. (AAD, antiarrhythmic drug; AF, atrial fibrillation; AFl, atrial flutter; BB, β-blocker; CCB, calcium channel blocker [ie, verapamil or diltiazem]; DCC, direct current cardioversion; TEE, transesophageal echocardiogram.) Source: The Arrhythmias, Pharmacotherapy: A Pathophysiologic Approach, 10e Citation: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at: https://accesspharmacy.mhmedical.com/DownloadImage.aspx?image=/data/books/1861/dipipharm10_ch18_f005.png&sec=146057096&BookID=1861&ChapterSecID=146057036&imagename= Accessed: November 13, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved