Patients with atrial fibrillation who present to the Emergency Department with chest pain can be evaluated based on ST segment changes on the admission electrocardiogram. This can help in the decision to discharge a patient or to admit for further evaluation to exclude a myocardial infarction. The authors are from Beth Israel Deaconess Medical Center in Boston.


Criteria for admission:

(1) atrial fibrillation with chest pain

(2) presence of either:

(2a) any ST segment elevation

(2b) a decrease in the ST segment by > 2 mm


If neither ST-segment criteria was met, then the patient could be discharged.



• Chest pain alone had a sensitivity of 100% but a specificity of 65%. Chest pain is a relatively common and nonspecific finding in patients with atrial fibrillation.

• For the above criteria the sensitivity was 100%, specificity 99%, positive predictive value 86% and negative predictive value 100%.

• The authors felt that this rule could reduce the number of patients admitted for workup by 94% with no loss in sensitivity.


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