A systematic review of available evidence for the management of adults with newly detected AF. Recommendations:

1. Rate control is the primary recommendation. Rhythm control is appropriate if symptoms, exercise, and patient preference indicate it.

2. Chronic anticoagulation.

3. Drugs with demonstrated efficacy of rate control during exercise and rest include atenolol, metoprolol, diltiazem, and verapamil. Digoxin is only effective for rate control at rest.

4. If cardioversion is chosen, either direct current cardioversion or pharmacological conversion is appropriate.

5. Anticoagulation pre- and post-cardioversion is required. If cardioversion is done acutely then transoesophageal echocardiography is performed to exclude intracardiac thrombus. Most patients with newly detected first episode of acute AF converted to sinus rhythm may not be placed on rhythm maintenance therapy as the risks outweigh the benefits.