Atrial fibrillation lasting less than 48 hours and patient is haemodynamically stable

Haemodynamically stable patients with an atrial fibrillation episode lasting less than 48 hours are at a lower risk of acute thromboembolic complications; an initial rate or rhythm control strategy can be offered to the patient (see Rate control for atrial fibrillation and Acute rhythm control for atrial fibrillation).

If rhythm control is used in haemodynamically stable patients with atrial fibrillation lasting less than 48 hours, anticoagulant therapy should be used at the time of cardioversion and continued long term, depending on the patient’s thromboembolic risk (see Stroke and bleeding risk assessment for atrial fibrillation).

The duration of an atrial fibrillation episode can be difficult to determine because many patients only develop symptoms when their ventricular rate becomes elevated. If there is doubt about the duration, treat as for atrial fibrillation lasting longer than 48 hours.