Q: What are the signs of haemodynamic instability?

Hypotension (SBP < 90 mmHg), altered mental status, chest pain/ischaemia, severe dyspnoea, or decompensated heart failure. Prioritise electrical cardioversion and specialist support.

Q: How does AF duration guide cardioversion?

If duration is 48 hours or unknown, use ≥3 weeks of effective anticoagulation or a TOE-guided strategy to exclude thrombus before cardioversion.

Question 1

How is atrial fibrillation diagnosed in the emergency setting?

Accepted Answer

With a 12-lead ECG showing disorganised atrial activity (no clear P waves) and irregularly irregular RR intervals. In an irregular wide-QRS tachyarrhythmia, suspect an accessory pathway until proven otherwise.

Question 2

What are the signs of haemodynamic instability?

Accepted Answer

Hypotension (SBP < 90 mmHg), altered mental status, chest pain/ischaemia, severe dyspnoea, or decompensated heart failure. Prioritise electrical cardioversion and specialist support.

Question 3

How does AF duration guide cardioversion?

Accepted Answer

If duration is <48 hours, immediate cardioversion may be considered. If >48 hours or unknown, use ≥3 weeks of effective anticoagulation or a TOE-guided strategy to exclude thrombus before cardioversion.

Question 4

Who should receive anticoagulation and for how long?

Accepted Answer

Base the decision on the CHA2DS2-VASc score. After cardioversion, continue anticoagulation for at least 4 weeks and long-term according to thromboembolic and bleeding risk; aspirin does not replace anticoagulation.

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