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Management of new onset atrial fibrillation

Robert Phang, MD, FACC, FHRS
Brian Olshansky, MD
Section Editors
Peter J Zimetbaum, MD
Hugh Calkins, MD
James Hoekstra, MD
Deputy Editor
Gordon M Saperia, MD, FACC


This topic will discuss the initial management of patients who are given a diagnosis of atrial fibrillation (AF). The majority of such patients can receive early care in a practitioner’s office, an urgent care center, or an emergency department.

The diagnosis of new onset AF is usually made with an electrocardiogram or other electrocardiographic rhythm recording device (eg, ambulatory or inpatient monitoring). (See "Overview of atrial fibrillation", section on 'Electrocardiogram'.)

This topic will address the following management decisions, which need to be made soon after a patient presents with new onset AF (algorithm 1):

When and how should rate control be carried out? (See 'Rate control' below.)

Is cardioversion indicated and if so should it be urgent? (See 'Urgent management' below and 'Restoration of sinus rhythm' below.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 02, 2016.
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