| 1. In patients with a life‐threatening deterioration in haemodynamic stability after the onset of atrial fibrillation, emergency electrical cardioversion should be performed, irrespective of the duration of the atrial fibrillation. |
| 2. In patients with non‐life‐threatening haemodynamic instability after the onset of atrial fibrillation, the following should be considered: |
| a. electrical cardioversion |
| b. where there is a delay in organising electrical cardioversion, intravenous amiodarone should be used |
| c. in those with known Wolff–Parkinson–White syndrome: |
| –flecainide is an alternative for attempting pharmacological cardioversion |
| –atrioventricular node blocking agents (such as diltiazem, verapamil or digoxin) should not be used. |
| 3. In patients with known permanent atrial fibrillation in which haemodynamic instability is caused mainly by a poorly controlled ventricular rate, a pharmacological rate control strategy should be used. |
| 4. Where urgent pharmacological rate control is indicated, intravenous treatment should be given with one of the following: |
| a. β‐blockers or rate‐limiting calcium antagonists |
| b. amiodarone, where β‐blockers or calcium antagonists are contraindicated or ineffective. |
