To study signs and symptoms by scale EHRA, type of paroxysm flow and structural-functional state of the myocardium in hypertensives with newonset atrial fibrillation (NOAF) depending on the presence of insulin resistance was aim. The study included 114 hypertensives (66 male, 48 female; age: 66 10 years) with NOAF. Depending on the endogenous insulin (EI) levels patients were divided into 3 groups: group 1 consisted of 44 patients with normal plasma EI levels; group 2 consisted of 31 patients with reactive hyperinsulinemia (HI); group 3 consisted of 39 patients with spontaneousHI.Oral glucose-tolerant testwith a parallel determination of plasma glucose (oxidase method) and EI levels (ELISA), holter monitoring electrocardiogram, echocardiography were measured. Control group included 20 healthy individuals. Paroxysmal and persistent AF often recorded in those without insulin resistance, permanent mainly in the HI. The risk of thromboembolism byCHA2DS2-VASc is the highest in 79 (69.30%) cases,mainly in the patients withHI. The severity of AF by scale EHRA I-II classes is in 30 (68.18%) patients (group 1), III-IV classes is in 22 (70.97%) (group 2) and 30 (76.92%) (group 3). In 36 (31.58%) patients vagal type of atrial fibrillation (AF) in 30 (26.31%) cases adrenergic type AF and in 48 (42.11%) cases mixed type AF were diagnosed. Adrenergic type AF under the HI is characterized by a decrease in time heart rate variability (HRV), in particular, RMSSD from 22.87 1.36 msec (group 1) to 17.24 1.31 msec (group 2 and 3) and increasing SDANN from 137.22 msec (group 1) to 148.39 4.27 msec (group 2 and 3) parameters, which is accompanied by an increase in the diameter of the left atriumover 4.0 cm in 8 (18.18%) (group 1); 7 (22.58%) (group 2); 14 (35.89%) (group 3) and left ventricular mass over 1.5 times (group 1) and 1.8 times (group 2 and 3) comparedwith the patients with vagal and mixed types (p<0.05). There are preserved LV systolic function and clinical signs of heart failure I-II NYHA. Thus, in hypertensives with insulin resistance and reactive/spontaneous HI under NOAF permanent form of AF is formedmore often with an increased risk of thrombotic events and increasing complaints associatedwith arrhythmias by a scale EHRA and progression of chronic heart failure. The increase in the metric and volume left heart indexes is accompanied by an imbalance between the sympathetic and parasympathetic links autonomic nervous system, the formation of the adrenergic type of AF.