Atrial Fibrillation (AF)

• ECG confirmation:
  • Confirm AF by visually reviewing a 12-lead ECG or rhythm-device recording.
  • An irregular pulse or optical smartwatch alert alone does not confirm AF.
• Intermittent episodes:
  • Match monitoring duration to symptom frequency; consider extended monitoring after unexplained stroke or systemic embolism.

• Urgent care: AF-related instability requires immediate synchronized cardioversion. New focal neurologic symptoms require emergency stroke assessment.
• Initial evaluation:
  • Review onset, symptoms, medications, alcohol, and comorbidities.
  • Obtain echocardiography, a complete blood count, metabolic panel, and thyroid testing; assess ventricular function, valves, renal function, and electrolytes.

Confirm atrial high-rate episodes and duration. Without prior clinical AF, U.S. guidance supports considering anticoagulation through shared decisions for episodes ≥24 hours with CHA₂DS₂-VASc ≥2, or 5 minutes to <24 hours with score ≥3. Episodes <5 minutes alone do not warrant anticoagulation.

AF during illness or surgery can recur; arrange follow-up and stroke-risk reassessment. During critical illness due to sepsis, benefit from anticoagulation for AF stroke prevention is uncertain.