skip to main content

Recent-onset atrial fibrillation — RCPSC EM MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiovascular emergenciesRecent-onset atrial fibrillationRCPSC EM

A 69-year-old has symptomatic atrial fibrillation of clearly documented 10-hour duration, rate 148/min, BP 132/78 mmHg and no heart failure, acute coronary syndrome or secondary trigger. What is the most appropriate acute strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Plan monitored rhythm control after assessing anticoagulation requirements

The best answer is “Plan monitored rhythm control after assessing anticoagulation requirements”. For stable recent-onset AF without an acute precipitating illness, Canadian guidance supports a rhythm-control strategy using electrical or pharmacological cardioversion after appropriate stroke-risk and anticoagulation assessment. Immediate cardioversion without considering anticoagulation is incomplete, while aspirin, prolonged passive observation or indefinite deferral may leave the patient unnecessarily symptomatic.

Reference: Canadian Cardiovascular Society: Atrial Fibrillation—Arrhythmia Management: https://ccs.ca/guideline/2020-atrial-fibrillation/chapter-9-arrhythmia-management/