Atrial fibrillation for the Acute physician

Atrial fibrillation (AF) is the most common arrhythmia in patients admitted to acute medical unit (AMU) and its prevalence increases with age. Acutely ill patients who suffer AF can be known to have AF - preexisting or can suffer from new onset AF secondary to the acute illness. Loss of atrial systole in presence of rapid ventricular response (RVR) can lead to a reduction in cardiac output and further hemodynamic compromise. New-onset AF in an acutely ill patient increase the risk of morbidity and mortality and is considered a marker of disease severity, priorities for the acute physician are to evaluate the hemodynamic status of the patient suffering with AF with RVR and consider urgent direct current cardioversion (DCCV) if evidence of hemodynamic compromise. Following steps after ensuring hemodynamic stability are to treat the cause of AF as well as assess for pharmacological treatment aiming for rate or rhythm control. New onset AF is also associated with an increase in the risk of heart failure, stroke, and death, there is evidence now that new onset AF in hospital is associated with 50% chance of recurrence within one year of discharge.