New-onset atrial fibrillation

Last reviewed: 2 Sep 2022
Last updated: 21 Apr 2021

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
  • diabetes mellitus
  • hypertension
  • congestive heart failure
  • valvular heart disease
  • coronary artery disease (CAD)
  • other atrial arrhythmias
  • cardiac or thoracic surgery
  • hyperthyroidism
  • hypoxic pulmonary conditions
  • alcohol intoxication
  • obesity
  • smoking
  • inflammatory disorders
  • excessive exercise
  • height
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

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 is an author of a number of references cited in this topic.

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

Cardiovascular and Heart Rhythm Consultant

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 is an author of a number of references cited in this topic.

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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  • Guidelines

    • 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)
    • 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation
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  • Patient leaflets

    Atrial fibrillation: what is it?

    Atrial fibrillation: what treatments work?

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  • Calculators

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    HAS-BLED Bleeding Risk Score

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