When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Established atrial fibrillation

Última revisão: 18 Sep 2025
Última atualização: 22 Nov 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presence of risk factors
  • palpitations
  • tachycardia
  • irregular pulse
Detalhes completos

Outros fatores diagnósticos

  • stroke
  • shortness of breath
  • fatigue
  • chest pain
  • dizziness
  • syncope
  • hypotension
  • elevated jugular venous pressure
  • murmur or gallop rhythm
  • rales
  • decrease in mentation or listlessness
Detalhes completos

Fatores de risco

  • hypertension
  • coronary artery disease (CAD)
  • congestive heart failure
  • advancing age
  • diabetes mellitus
  • valvular disease
  • hypertrophic cardiomyopathy
  • alcohol misuse
  • presence of other arrhythmias
  • smoking
  • obesity
  • sleep-disordered breathing (SDB)
  • chronic obstructive pulmonary disease (COPD)
  • chronic kidney disease (CKD)
  • sedentary lifestyle
  • thyroid disease
  • autonomic neuronal dysfunction
  • caffeine misuse
  • cancer
  • working long hours
  • excessive exercise
  • height
  • air pollution
  • migraine
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • ECG
  • thyroid profile
  • echocardiogram
  • serum urea and electrolytes (including serum magnesium)
Detalhes completos

Investigações a serem consideradas

  • serum transaminases
  • prolonged ECG monitoring
  • fasting blood glucose or HbA1c
  • screening for sleep-disordered breathing (SDB)
Detalhes completos

Algoritmo de tratamento

AGUDA

paroxysmal or persistent AF: haemodynamically unstable

CONTÍNUA

paroxysmal or persistent AF and haemodynamically stable: rate-control strategy selected

paroxysmal or persistent AF and haemodynamically stable: rhythm-control strategy selected

permanent AF

Colaboradores

Autores

Arti N. Shah, MS, MD

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York

NY

Disclosures

ANS declares that she has no competing interests.

Bharat K. Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS

President, Cardiovascular and Heart Rhythm Consultants

Clinical Professor of Medicine

Icahn School of Medicine at Mount Sinai

Attending and Consultant Cardiac Electrophysiologist

Mount Sinai and New York Presbyterian Hospitals

New York

NY

Disclosures

BKK declares that he has no competing interests. BKK is an author of a reference cited in this topic.

Peer reviewers

Andrew R.J. Mitchell, BM, MD, FRCP, FESC, FACC

Consultant Cardiologist

Jersey General Hospital

St Helier

Jersey

Channel Islands

Disclosures

ARJM declares that he has no competing interests.

Diwakar Jain, MD, FACC, FRCP, FASNC

Professor of Medicine (Cardiology)

Westchester Medical Center

Valhalla

NY

Disclosures

DJ declares that he has no competing interests.

Konstadinos Plestis, MD, FACS

Associate Professor

Department of Cardiothoracic Surgery

Mount Sinai Medical Center

New York

NY

Disclosures

KP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021 Feb 1;42(5):373-498.Full text  Abstract

National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. Jun 2021 [internet publication].Full text

Sharma M, Cornelius VR, Patel JP, et al. Efficacy and harms of direct oral anticoagulants in the elderly for stroke prevention in atrial fibrillation and secondary prevention of venous thromboembolism: systematic review and meta-analysis. Circulation. 2015 Jul 21;132(3):194-204.Full text  Abstract

Lip GY, Haguenoer K, Saint-Etienne C, et al. Relationship of the SAMe-TT₂R₂ score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation. Chest. 2014 Sep;146(3):719-26. Abstract

Kuck KH, Brugada J, Furnkranz A, et al; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45.Full text  Abstract

Luik A, Radzewtiz A, Kieser M, et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomized, controlled, noninferiority FreezeAF Study. Circulation. 2015 Oct 6;132(14):1311-9.Full text  Abstract

Del-Carpio Munoz F, Gharacholou SM, Munger TM, et al. Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am J Cardiol. 2016 Jan 1;117(1):69-75. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Established atrial fibrillation images
  • Differentials

    • Atrial flutter with variable atrioventricular (AV) conduction
    • Multifocal atrial tachycardia
    • Atrial tachycardia with variable AV conduction
    More Differentials
  • Guidelines

    • 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
    • ACR appropriateness criteria: preprocedural planning for left atrial procedures in atrial fibrillation
    More Guidelines
  • Patient information

    Atrial fibrillation

    Atrial fibrillation: what are the treatment options?

    More Patient information
  • Calculators

    Atrial Fibrillation CHA(2)DS(2)-VASc Score for Stroke Risk

    ORBIT Bleeding Risk Score

    More Calculators
  • Videos

    How to perform an ECG animated demonstration

    More videos
  • padlock-lockedInicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad