Summary
Definition
History and exam
Key diagnostic factors
- irregular pulse rate
Other diagnostic factors
- palpitations
- hypotension
- elevated jugular venous pressure
- added heart sounds
- dizziness
- dyspnea
- rales
- evidence of stroke
Risk factors
- increasing age
- hypertension
- orthostatic hypotension
- diabetes mellitus
- heart failure
- valvular and structural heart disease
- coronary artery disease and acute coronary syndromes
- other atrial arrhythmias
- sepsis and critical illness
- cardiac or thoracic surgery
- obesity
- hyperthyroidism
- hypoxic pulmonary conditions
- alcohol consumption
- smoking
- inflammatory disorders
- excessive exercise
- height
- cancer and chemotherapy
Diagnostic investigations
1st investigations to order
- ECG
- serum electrolytes
- cardiac biomarkers
- thyroid function tests
- CXR
- transthoracic echocardiogram
- transesophageal echocardiogram (TEE)
Investigations to consider
- electrophysiologic study
- exercise stress tests
Treatment algorithm
hemodynamically unstable
hemodynamically stable with left atrial thrombus, or presence of thrombus unknown/duration of AF unknown
hemodynamically stable without left atrial thrombus: symptom onset <48 hours
hemodynamically stable without left atrial thrombus: symptom onset ≥48 hours
hemodynamically stable without left atrial thrombus: asymptomatic
Contributors
Authors
Arti N. Shah, MS, MD
Director
Cardiac Electrophysiology
Elmhurst Hospital Center
Elmhurst
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
Clinical Professor of Medicine
Icahn School of Medicine at Mount Sinai
President
Cardiovascular and Heart Rhythm Consultants
Attending and Consultant Cardiac Electrophysiologist
Mount Sinai Hospitals
New York Methodist Hospital
New York
NY
West Houston Medical Center
Memorial Hermann Hospital
Houston
TX
Disclosures
BKK declares that she has no competing interests.
Peer reviewers
Diwakar Jain, MD, FACC, FRCP, FASNC
Professor of Medicine (Cardiology)
Westchester Medical Center
Valhalla
NY
Disclosures
DJ declares that he has no competing interests.
Farooq A. Padder, MD, MRCP, FACC
Assistant Professor of Medicine
Hahnemann University Hospital
Woodbury
NJ
Disclosures
FAP declares that he has no competing interests.
Kim Rajappan, MA, MD, MRCP
Consultant Cardiologist and Electrophysiologist
Cardiac Department
John Radcliffe Hospital
Oxford
UK
Disclosures
KR declares that she has no competing interests.
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