In a rural mountainous region on a Friday, a 78-year-old man was seen in his physician’s office for leg edema and diagnosed with new onset atrial fibrillation. He was discharged home to start medications for atrial fibrillation and heart failure. He was hospitalized the next day with septic shock due to pneumococcal pneumonia. The new onset of atrial fibrillation requires a trigger acting on a vulnerable substrate. These triggers include acute conditions such as alcohol intoxication, myocardial infarction and pulmonary embolism. Pneumonia may act as a trigger causing the new onset of atrial fibrillation.