New-onset atrial fibrillation

Chaotic and irregular atrial arrhythmia, the prevalence of which increases progressively with age and affects almost 5% of the population over 69 years of age.

Causes significant morbidity and mortality including palpitations, dyspnea, angina, dizziness or syncope, and features of congestive heart failure (CHF), tachycardia-induced cardiomyopathy, stroke, and death.

ECG shows absent P waves, presence of fibrillatory waves, and irregularly irregular QRS complexes.

Most patients presenting with new-onset or “acute” atrial fibrillation (AF) do not require immediate cardioversion. Most patients will require medical therapy to control ventricular rate.

Patients who develop hemodynamic compromise should have immediate direct current cardioversion.

If the precise timing of the onset of AF is unclear, a transesophageal echocardiogram must be performed to exclude left atrial clots before cardioversion.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia. It is characterized by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular (AV) conduction is intact.[1]Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011;123:e269-e367. http://circ.ahajournals.org/content/123/10/e269.long http://www.ncbi.nlm.nih.gov/pubmed/21382897?tool=bestpractice.com New-onset AF is defined as a new onset or a first detectable episode of AF, whether symptomatic or not.

This topic will concentrate on new-onset AF in the nonvalvular and nonsurgical settings.