Management of newly discovered atrial fibrillation
First episode of atrial fibrillation:
- The diagnosis should be confirmed by 12 lead ECG.
- If heart rate causing haemodynamic compromise (low BP, heart failure, chest pain, dizziness, syncope), then refer for immediate hospital admission.
- Blood tests: FBC, U&E, creatinine, LFT, TFT.
- Echocardiogram: Arrange echocardiography and consider referral for cardioversion if atrial fibrillation persists. Treatable causes should be identified and treated appropriately.
- Chest x-ray.
- If required, 24 hour ECG, event recorder, treadmill test etc.
- Underlying causes may include: hypertension, coronary artery disease, alcohol excess, acute systemic infection, thyrotoxicosis, pulmonary embolism, post-cardiac surgery.
- See the Decision making guide for anticoagulation in non-valvular atrial fibrillation for details on assessing stroke risk and need for antithrombotic therapy in AF.