“‘latex Atrial fibrillation (AF) is common and occurs in approximately 8% of adults over sixty-five years of age in the United States.[1](#ref-0001) Prevention of AF, with maintenance of healthy weight, treatment of sleep apnea, and regular exercise are key strategies. As prevention is often inadequate, the role of antiarrhythmic drugs (AADs) is paramount. The risk of adverse events during initiation is greatest in the first 24 hours, and is approximately 10-15%, but AADs can still be used safely.[2](#ref-0002) Herein, we describe the various categories in a practical guide to initiation in order to make clinicians more comfortable with starting and maintaining antiarrhythmic therapy in both the inpatient and outpatient setting. The central illustration summarizes the article.