New-onset atrial fibrillation

Last reviewed: 31 Dec 2022
Last updated: 04 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • irregular pulse rate
More key diagnostic factors

Other diagnostic factors

  • palpitations
  • hypotension
  • elevated jugular venous pressure
  • added heart sounds
  • dizziness
  • dyspnea
  • rales
  • evidence of stroke
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • serum electrolytes
  • cardiac biomarkers
  • thyroid function tests
  • CXR
  • transthoracic echocardiogram
  • transesophageal echocardiogram (TEE)
More 1st investigations to order

Investigations to consider

  • electrophysiologic study
  • exercise stress tests
More investigations to consider

Treatment algorithm

INITIAL

hemodynamically unstable

ACUTE

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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