Background: Acute coronary syndromes (ACS) are one of the major causes of mortality & morbidity worldwide. Current guidelines recommend dual antiplatelet therapy in patients with ACS. This study aimed to predict AF in ACS patients using ticagrelor or clopidogrel by tissue Doppler derived atrial Dyssynchrony. Methods: This was an observational, case series, single center study, was carried out at coronary care unit at “Benha University hospital" on 200 patients with ACS (STEMI & Non-STEMI), 100 of the patients used ticagrelor and the other 100 patients used clopidogrel, in the period from June 2022 to December 2022. Results: The incidence of AF was insignificantly different between the studied groups. LAVI max and Mitral regurgitation was significantly higher in New‐onset AF patients (P value=0.024, 0.001 respectively). Tissue Doppler imaging data (Lateral mitral P-A' interval, septal mitral P-As interval, tricuspid P-A' interval, LA Dyssynchrony and Inter-atrial Dyssynchrony) were significantly higher in New‐onset AF patients (P value7.792 ms, with 68.2 % sensitivity, 63.5 % specificity, 18.7 PPV and 94.2 NPV. Conclusion: Our study showed that there was no significant difference in electro-echocardiographic AF predictors such as PWD, LAVI max, left atrial dyssynchrony and interatrial dyssynchrony in ACS patients who received ticagrelor or clopidogrel.