Cardiology  |  Atrial Fibrillation Pathway - Assessment


Atrial Fibrillation Pathway - Assessment

Consider the following in the initial assessment:

  • Confirm rhythm diagnosis on ECG (note that atrial flutter can be difficult to differentiate from sinus tachycardia- look for the typical saw tooth pattern of atrial flutter, which may not be present in all leads).
  • If paroxysmal atrial fibrillation is suspected , consider refer to Cardiology OPD for consideration of Holter monitoring or event monitoring - see Palpitations pathway.
  • Teach patient to take own pulse and keep symptom diary.
  • Bloods to include - CBC, renal function, electrolytes, TFTs, INR (if warfarin is to be initiated).
  • Assess thromboembolic risk and for suitability for anticoagulation.

Consider causes:

  • Cardiac causes including - cardiomyopathy, valvular heart disease, coronary arterial disease, MI
  • Respiratory causes including - COPD, sleep apnoea, PE
  • Infection
  • Surgery
  • Metabolic
  • Thyrotoxicosis
  • Alcohol

Types of Atrial Fibrillation:

Paroxysmal AF

  • Recurrent (at least two episodes) of spontaneously resolving AF that resolve within 7 days (although usually within 24 hours).

Persistent AF

  • AF that fails to terminate within 7 days.

Permanent AF

  • AF that lasts longer than a year when attempts at cardioversion have failed or not been attempted.

Anti-coagulation decisions should be made independently of the above types of AF as the risk of thromboembolism should be considered the same in paroxysmal AF compared to the persistent and permanent forms. The RACE and AFFIRM studies indicate that there is no risk reduction benefit in an asymptomatic (or minimally symptomatic) rate controlled patient when comparing rhythm versus rate control strategies.

Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

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