Introduction: Atrial fibrillation (AF) is a common arrhythmia and often becomes persistent with a high risk of thromboembolism event. Spontaneous conversion to sinus rhythm can occur in 50% of cases with new-onset AF. In this case report we report the spontaneous conversion of AF to sinus rhythm in patients with Unstable Angina without any thromboembolic complications.
Case description: A 65-year-old man with unstable angina pectoris (UA) with new-onset atrial fibrillation normal ventricular rate (AF-NVR) came to the Emergency Department Bali Mandara General Hospital. Patients have a history of uncontrolled hypertension and active smokers. Standard management of UA using dual antiplatelet, nitrates, and anticoagulants was given to this patient. There were no anti-arrhythmia drugs given to seek for AF cardioversion. Within 6 hours after initial therapy, spontaneous conversion of AF to sinus rhythm occurs. The patient was treated for five days in a stable condition without thromboembolic complications. Long-term anticoagulants were not given to patients because the CHA2DS2-Vasc score is less than two indicating a low risk of thromboembolism.
Conclusion: New-onset AF has the chance of spontaneous conversion to sinus rhythm within 48 hours, proper management of the trigger factors of AF and optimal rate control are determinants of prognosis. Provision of long-term anticoagulants must be based on the CHA2DS2-Vasc score.