New-onset atrial fibrillation

Patients presenting with new-onset AF who have paroxysmal, persistent, or permanent AF need long-term follow-up. Depending on the nature of the underlying cause of AF (i.e., coronary artery disease, valvular heart disease, or heart failure), patients should have regular (minimum 6-12 months) echocardiograms and consideration of exercise stress testing. Risk factors for thromboembolism and bleeding change with time; patients should be reassessed at regular intervals, including re-calculation of the CHADS2-VASC score and HASBLED score. This is to ensure the patient remains on the most appropriate treatment long term, and so that modifiable risk factors can be addressed.[167]Chang TY, Lip GYH, Chen SA, et al. Importance of risk reassessment in patients with atrial fibrillation in guidelines: Assessing risk as a dynamic process. Can J Cardiol. 2019 May;35(5):611-8. http://www.ncbi.nlm.nih.gov/pubmed/31030863?tool=bestpractice.com

Patients who are taking antiarrhythmic agents need follow-up for ECG monitoring. Exercise stress testing is recommended to assess for use-dependence proarrhythmia of ventricular tachycardia in patients taking flecainide and propafenone.

A regular follow-up to check and monitor the international normalized ratio is mandatory for those patients who are taking warfarin for anticoagulation. Routine monitoring of digoxin levels is not required but levels can be checked if toxicity or inadequate dosing is suspected.