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Chronic atrial fibrillation

Last reviewed: 10 Nov 2023
Last updated: 12 Jan 2023



History and exam

Key diagnostic factors

  • presence of valvular heart disease, coronary artery disease, hypertension, pericarditis, cardiomyopathy, and other arrhythmias
  • presence of diabetes mellitus, thyroid disease, alcohol abuse, and cancer
  • palpitations
  • tachycardia
  • irregular pulse
More key diagnostic factors

Other diagnostic factors

  • stroke
  • shortness of breath
  • fatigue
  • chest pain
  • dizziness
  • hypotension
  • elevated jugular venous pressure
  • murmur or gallop rhythm
  • rales
  • decrease in mentation or listlessness
Other diagnostic factors

Risk factors

  • hypertension
  • coronary artery disease
  • congestive heart failure
  • advancing age
  • diabetes mellitus
  • valvular disease
  • hypertrophic cardiomyopathy
  • alcohol abuse
  • male sex
  • presence of other arrhythmias
  • smoking
  • obesity
  • thyroid disease
  • autonomic neuronal dysfunction
  • sleep-disordered breathing
  • caffeine abuse
  • cancer
  • working long hours
  • excessive exercise
  • height
  • chronic obstructive pulmonary disease
  • chronic kidney disease
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • thyroid profile
  • echocardiogram
  • serum electrolytes (including serum magnesium) and BUN
More 1st investigations to order

Investigations to consider

  • serum aminotransferases
  • prolonged ECG monitoring
More investigations to consider

Treatment algorithm


paroxysmal or persistent AF: hemodynamically unstable

paroxysmal or persistent AF: hemodynamically stable


permanent AF



Arti N. Shah, MS, MD

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York



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



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


Channel Islands


ARJM declares that he has no competing interests.

Diwakar Jain, MD, FACC, FRCP, FASNC

Professor of Medicine (Cardiology)

Westchester Medical Center




DJ declares that he has no competing interests.

Konstadinos Plestis, MD, FACS

Associate Professor

Department of Cardiothoracic Surgery

Mount Sinai Medical Center

New York



KP declares that he has no competing interests.

  • Chronic atrial fibrillation images
  • Differentials

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  • Guidelines

    • 2020 update to the 2016 ACC/AHA clinical performance and quality measures for adults with atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures
    • Atrial fibrillation: diagnosis and management
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  • Patient leaflets

    Atrial fibrillation

    Atrial fibrillation: what treatments work?

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  • Calculators

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

    ORBIT Bleeding Risk Score

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  • Videos

    How to perform an ECG: animated demonstration

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