For patients with newly diagnosed AF who are at high risk for cardiovascular complications and especially if the patient is symptomatic, we suggest a rhythm-control rather than a rate-control strategy, provided it can be initiated within 12 months of onset (Grade 2C). High risk is defined as >75 years of age, prior transient ischemic attack or stroke, or two of the following criteria: age >65 years, female sex, heart failure, hypertension, diabetes, severe coronary artery disease, chronic kidney disease, and left ventricular hypertrophy (diastolic septal wall width >15 mm). (See 'EAST-AFNET 4' above.)

Source: UpToDate