Atrial Fibrillation / Flutter

Consider admission if:

·         New onset Atrial fibrillation/flutter within the last 48 hours associated with haemodynamic   instability(e.g. pulse of >150 and/or systolic BP < 90mmHg)

·         Atrial Fibrillation/flutter associated with syncope, chest pain, heart failure and/or shortness of breath

 The majority of patients diagnosed with atrial fibrillation can be managed in the community.

 Consider referral for rate control strategy if:

  • On-going symptoms or  inadequate rate control despite community medical management(Aim for resting pulse <110bpm, or < 80bpm in those who remain symptomatic)
  • The patient has structural heart disease
  • Symptomatic confirmed bradyarrhythmia or asymptomatic daytime pauses  > 2.8 secs or nocturnal  > 4secs

Consider referral for rhythm control strategy if:

  • On-going limiting symptoms despite adequate rate control
  • Patients who are younger (generally < 65years)
  • Patients have had either self-limiting or a corrected trigger e.g. infection, throtoxicosis, PE, Surgery but have persistent AF
  • The patient has heart failure
  • The ECG in sinus rhythm suggests an electrophysiological disorder e.g. short PR interval/delta wave

Prior to referral:

·         Attach A 12 Lead ECG

·         FBC, UE, Thyroid function test

·         Consider chest x-ray if breathless

·         A community ECHO has been requested when appropriate (click here for ECHO guidelines)

·         Community medical management is optimised

·         If referring for rhythm control please ensure the patient has no comorbidities precluding                general anaesthetic and they are prepared to undergo a period of formal anticoagulation.


Date reviewed                     05/07/2021

Next review due                  05/07/2022

Sifter name                         Elizabeth Fell / Bridgitte Wesson

Contributors                        Dr Louise Melley – Assistant Specialist Cardiology RCHT

Version 2.1