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New AF Management — RACP Adult Medicine MCQ

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EasyCardiologyNew AF ManagementRACP Adult Medicine

A 65-year-old man presents with new-onset AF (48 hours duration). He is haemodynamically stable (HR 130, BP 130/80). He has LVEF 55% with no structural heart disease. CHA₂DS₂-VASc score is 2. He is symptomatic with palpitations and dyspnoea. What is the most appropriate initial management?

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Correct answer: D — Rate control with metoprolol then consider rhythm control

New-onset AF with haemodynamic stability should be rate-controlled initially (target HR <110 bpm at rest). Beta-blockers (metoprolol) or CCBs (diltiazem/verapamil) are first-line. The EAST-AFNET 4 trial showed early rhythm control (within 1 year of diagnosis) reduces cardiovascular events vs rate control alone. After rate control, consider rhythm control strategy (cardioversion or antiarrhythmics) especially if symptomatic. Anticoagulation per CHA₂DS₂-VASc.

Reference: CSANZ – 2024 – AF Guidelines; ESC 2024 AF; EAST-AFNET 4