47
Important Comorbidities in HF
Atrial Fibrillation
Table 27. Clinical Evaluation in Patients With AF
Minimum Evaluation
1. History and
physical
examination
To define:
Presence and nature of symptoms associated with AF
Clinical type of AF (paroxysmal, persistent, or permanent)
Onset of first symptomatic attack or date of discovery of AF
Frequency, duration, precipitating factors, and modes of
termination of AF
Response to any pharmacological agents that have been
administered
Presence of any underlying heart disease or other reversible
conditions (eg, hyperthyroidism or alcohol consumption)
2. ECG To define:
Rhythm (verify AF)
LV hypertrophy
P-wave duration and morpholog y or fibrillatory waves
Preexcitation
Bundle-branch block
Prior MI
Other atrial arrhythmias
To measure and follow the R-R, QRS, and QT intervals in
conjunction with antiarrhythmic drug therapy
3. Transthoracic
echocardiogram
To identify:
Valvular heart disease
LA and RA size
LV and RV size and function
Peak RV pressure (pulmonary hypertension)
LV hypertrophy
LA thrombus (low sensitivity)
Pericardial disease
4. Blood tests of
thyroid, renal, and
hepatic function
For a first episode of AF, when the ventricular rate is difficult to
control
Reproduced from Fuster V, et al. Circulation. 2011;123:e269-e367.
