CirculationAHA SCIENTIFIC STATEMENTAtrial Fibrillation Occurring During AcuteHospitalization:A Scientific Statement From theAmerican Heart AssociationJanice Y.Chyou,MD,FAHA,Chair;Ebrahim Barkoudah,MD,MPH;Jonathan W.Dukes,MD;Larry B.Goldstein,MD,FAHA;Jose A.Joglar,MD,FAHA;Anson M.Lee,MD;Steven A.Lubitz,MD,MPH,FAHA;Keith A.Marill,MD,MS;Kevin B.Sneed,PharmD;Megan M.Streur,PhD,ARNP;Graham C.Wong,MD,MPH,FAHA;Rakesh Gopinathannair,MD,MA,FAHA,Vice Chair;on behalfof the American Heart Association Acute Cardiac Care and General Cardiology Committee,Electrocardiography and ArrhythmiasCommittee,and Clinical Pharmacology Committee of the Council on Clinical Cardiology;Council on Cardiovascular Surgery andAnesthesia;Council on Cardiopulmonary,Critical Care,Perioperative and Resuscitation;Council on Cardiovascular and StrokeNursing;and Stroke CouncilABSTRACT:Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness;atrialfibrillation may be detected or managed for the first time during acute hospitalization for another condition.Atrial fibrillationafter cardiothoracic surgery is a distinct type of acute atrial fibrillation.Acute atrial fibrillation is associated with high riskof long-term atrial fibrillation recurrence,warranting clinical attention during acute hospitalization and over long-termfollow-up.A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation.Acutemanagement requires a multipronged approach with interdisciplinary care collaboration,tailoring treatments to the patient'sunderlying substrate and acute condition.Key components of acute management include identification and treatment oftriggers,selection and implementation of rate/rhythm control,and management of anticoagulation.Acute rate or rhythmcontrol strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricularoadeddyssynchrony,and the patient's ability to tolerate the risk of the therapeutic strategy.Given the high risks of atrial fibrillationrecurrence in patients with acute atrial fibrillation,clinical follow-up and heart rhythm monitoring are warranted.Long-termfrommanagement is guided by patient substrate,with implications for intensity of heart rhythm monitoring,anticoagulation,andhttp:/considerations for rhythm management strategies.Overall management of acute atrial fibrillation addresses substrates andtriggers.The 3As of acute management are acute triggers,atrial fibrillation rate/rhythm management,and anticoagulation.The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors,in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation.Several gaps in knowledgerelated to acute atrial fibrillation exist and warrant future research.Key Words:AHA Scientific Statements atrial fibrillation critical illness hospitalization pos
