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'''New onset atrial fibrillation
'''New onset atrial fibrillation'''<br>
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(Paroxysmal or persistent or permanent) <br> </div>}}
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Latest revision as of 06:40, 28 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

New Onset Atrial Fibrillation

Shown below is an algorithm depicting the management of patients with newly discovered atrial fibrillation based on the 2014 ACCF/AHA/HRS Guideline for the Management of Patients With Atrial Fibrillation.[1]

Abbreviations: AF: Atrial fibrillation; BP: Blood pressure; DC: Direct current; EF: Ejection fraction; HR: Heart rate; SBP: Systolic blood pressure

 
 
 
 
 
 
 
 

New onset atrial fibrillation

(Paroxysmal or persistent or permanent)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Stable:
❑ Asymptomatic
OR

❑ Mild to moderate symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient require heart rate control therapy?
 
 
 
 
 
 
 
Does the patient has any symptoms and signs of pulmonary edema?

Dyspnea
Crackles

Chest X-ray showing pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No (spontaneous cardioversion)
 
Yes
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Identify the underlying etiology and treat accordingly
❑ Proceed with anticoagulation strategy as shown below
 
❑ Proceed with the heart rate control strategy
 
 
 
Manage pulmonary edema:

❑ Initiate oxygen therapy
❑ High dose IV diuretics
❑ BP management

SBP 85 - 100 mm Hg (dobutamine or milrinone)
❑ SBP < 85 mm Hg (dopamine and norepinephrine)
 
Immediate DC cardioversion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Did the patient achieve heart rate control goal:

❑ Resting HR <110 bpm in asymptomatic and EF > 40% patients
❑ Resting HR <80 bpm in symptomatic and EF < 40% patients

 
 
 
After initial pulmonary edema management proceed with DC cardioversion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
Successful
 
Unsuccessful
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Identify the underlying etiology and treat accordingly
❑ Proceed with cardioversion strategy for initial symptomatic patients as shown below
❑ Proceed with anticoagulation strategy as shown below
 
❑ Identify the underlying etiology and treat accordingly
❑ Proceed with cardioversion strategy as shown below
❑ Proceed with anticoagulation strategy as shown below
 
Identify the underfying cause and treat accordingly
 
Repeat cardioversion:
❑ After adjusting the location of the electrodes and applying pressure over the electrodes
OR
❑ After administration of an antiarrhythmic medication
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proceed with the anticoagulation strategy
 
 
 
 
 


References

  1. January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC, Cigarroa JE; et al. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. doi:10.1016/j.jacc.2014.03.021. PMID 24685668.


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