6
Diagnosis
Table 3. Initial Clinical Evaluation in Patients With AF
Minimum Evaluation
History and physical
examination, to define
• Presence and nature of symptoms associated with AF
• Clinical type of AF (paroxysmal, persistent, or
permanent)
• Onset of the first symptomatic attack or date of
discovery of AF
• Frequency, duration, precipitating factors, and modes
of initiation or termination of AF
• Response to any pharmacological agents that have been
administered
• Presence of any underlying heart disease or reversible
conditions (e.g., hyperthyroidism or alcohol
consumption)
ECG, to identify • Rhythm (verify AF)
• LVH
• P-wave duration and morpholog y or fibrillatory waves
• Pre-excitation
• 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
TTE, to identify • VHD
• LA and RA size
• LV and RV size and function
• Peak RV pressure (pulmonary hypertension)
• LV hypertrophy
• LA thrombus (low sensitivity)
• Pericardial disease
Blood tests of thyroid, renal,
and hepatic function
• For a first episode of AF
• When the ventricular rate is difficult to control
Table 2. Clinical Evaluation
Recommendation COR LOE
ECG documentation is recommended to establish the
diagnosis of AF.
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