Data gathering
- Red flags
- Loss of consciousness
- Lightheaded
- Chest pain
- Significant breathlessness
- Haemodynamic instability
- Examine
- Pulse, BP, sats
- CV
- CCF signs
Clinical management
- Investigations
- Bloods – FBC, U+E, LFTs, TFTs, Ca, Mg, HbA1c, lipids
- ECG
- Echo (after rate controlled)
- Explanation
- Treatment
- Rate control
-
- Bisoprolol 1.25mg titrated upwards to max 10mg
- Aim rate 60-80bpm
- Follow-up after 1 week
- Poor rate control with single agent
- Digoxin monotherapy
- non-paroxysmal AF and sedentary patient
- Rhythm control
- Anticoagulation
- Refer to anticoagulation team
- CHA2DS2-VASc ≥ 1 for men + HAS-BLED ≤ 2
- CHA2DS2-VASc ≥ 2 for women + HAS-BLED ≤ 2
- HAS-BLED > 3, consider referral to cardiology
- Followup / Safety-net
- Urgent referral if red flags
- Onset of symptoms less than 48 hours
Rhythm Control
- Discuss with on-call cardiologist for consideration of cardioversion if
- onset of symptoms <48 hours
- symptomatic
- < 75 years old (or by discretion)
- first presentation with lone AF
- secondary to treated trigger
- congestive heart failure
- suitable for AF ablation
Exclude underlying causes or triggers
- Cardiac
- Hypertension
- Valvular heart disease
- Heart failure
- IHD
- Respiratory
- Chest infections
- PE
- Lung Ca
- Systemic
- Alcohol excess
- Thyrotoxicosis
- Electrolyte depletion
- Infections
- Diabetes