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

If patients have developed Atrial Fibrillation/flutter within the last 48 hours in patients who are haemodynamically stable where cardioversion is being considered, please discuss with the Acute GP Service or the Cardiologist of the Week (CoW).


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.