17-year-old presents to emergency room with “irregularly irregular” rhythm

Atrial fibrillation is one of the most common arrhythmias seen in older adults but rare in the young population. On occasion, atrial fibrillation may be the arrhythmia at the presentation of an adolescent with palpitations. Assessment of patients presenting with atrial fibrillation includes a detailed history of the start and stop of the palpitations with particular attention to any inciting events such as caffeinated beverages or cold drinks. Management of the young patient is driven in large part by adult guidelines though the risk of stroke is likely significantly lower as young patients do not have similar risk factors. Cardioversion is the usual treatment of choice and suggested performance of the procedure is reviewed.