This sheet answers common questions about being discharged from the emergency department [ED, also called accident and emergency or A&E] with a diagnosis of new atrial fibrillation or atrial flutter. If you would like further information, or have any worries, please don’t hesitate to ask your nurse or healthcare team.

What is atrial fibrillation or atrial flutter?

Atrial fibrillation and atrial flutter are the most common types of abnormal heart rhythms. You will have had an electrocardiogram (ECG), which tracks the rhythm of the heart, to confirm this. However, many people who have atrial fibrillation or atrial flutter do not have any symptoms.

Atrial fibrillation

When the upper chambers of the heartbeat irregularly. This can result in a faster or slower heartbeat than normal. It can sometimes cause symptoms such as dizziness, shortness of breath or blackouts.

Atrial flutter

When the upper chambers of the heartbeat faster than usual but in a regular rhythm. This can cause you to have a faster heartbeat than normal.

Atrial fibrillation and atrial flutter increase the risk of developing certain conditions such as a stroke or heart failure. Although they appear differently on an echocardiogram (ECG), these abnormal heart rhythms tend to occur in patients with particular health risks and can be managed in similar ways.

Are all patients given the same medications?

No. The decision to prescribe medications will be based on the assessment of your symptoms and risk factors.

What medications are prescribed?

If the doctors have identified atrial fibrillation or atrial flutter whilst you are in the emergency department, they may have prescribed you medication. These medications generally fall under two groups:

Anticoagulants (blood thinners) for stroke prevention

AF increases your risk of stroke by five times. A stroke happens when blood supply to part of the brain is interrupted. In AF, blood can form clots within the heart, due to the irregular rhythm. These clots can travel in the bloodstream to the brain causing a blockage and consequently a stroke or a transient ischaemic attack (TIA or mini stroke).

Some of the medications used as blood thinners which you may have been prescribed are:

  • Apixaban
  • Rivaroxaban
  • Edoxaban
  • Warfarin

To ensure they are effective at reducing your risk of a stroke, it is important to take blood thinners regularly and as prescribed.

Medications to regulate your heart rate or rhythm

Depending on your symptoms, your clinician may prescribe medications to help control your heart rate or attempt to regain a normal heart rhythm.

Some of the medications that you may have been prescribed are:

  • Bisoprolol
  • Diltiazem
  • Verapamil
  • Digoxin

Possible side effects

In a small number of people, blood thinners can cause bleeding from the gut or in the urine. If you notice blood in your sputum, stool or urine, or if you notice dark-coloured stool, please report these findings to a clinician. The clinical team will aim to treat this and advise you when it is safe to resume taking the blood thinners.

Some people may experience dizziness or shortness of breath after taking medications to regulate your heart rate. This is likely to be a drug side-effect, but it could also mean your heartrate has become too slow. Please report any symptoms to your clinician.

What should I do if I feel unwell?

Whilst you wait for the RAAF clinic appointment, if you experience significant, new or worsening symptoms such as significant dizziness, bleeding, or symptoms that cause
significant inability to undertake routine daily activity, you should return to ED for a further assessment.

If you experience signs of a stroke or loss of consciousness, or you require urgent medical assistance, call 999.

What happens next?

The ED doctors will refer you to the RAAF clinic. If you were prescribed anticoagulants (blood thinners), you will also be referred to the anticoagulation team.

What is the RAAF clinic?

The RAAF clinic is based at the Royal Free London. This service is run by the cardiac rhythm management (CRM) team, a group of specialist nurses and clinicians. The CRM team will help you manage your symptoms and co-ordinate your care. Once referred, you can expect to be contacted by a CRM nurse within three to five working days after attending ED. This will be a telephone appointment.

Most patients will be given a second appointment with the RAAF clinic to discuss your cardiac tests and further management. You may be referred for further specialist care or discharged back to your GP with a treatment plan.