A patient with atrial fibrillation should be urgently referred to a specialist if certain conditions are present.

Indications for urgent referral:

(1) hemodynamic instability

(2) uncontrollable heart rate

(3) symptomatic bradycardia not amenable to reduction of rate control agents

(4) severe angina

(5) worsening of left ventricular function

(6) transient ischemic attack or stroke

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