Atrial fibrillation: management

National Institute for Health and Care Excellence

Diagnosis and assessment

  • Perform manual pulse palpation to assess for the presence of an irregular pulse that may indicate underlying atrial fibrillation in people presenting with any of the following:
    • breathlessness/dyspnoea
    • palpitations
    • syncope/dizziness
    • chest discomfort
    • stroke/transient ischaemic attack
  • Perform an electrocardiogram (ECG) in all people, whether symptomatic or not, in whom atrial fibrillation is suspected because an irregular pulse has been detected
  • In people with suspected paroxysmal atrial fibrillation undetected by standard ECG recording:
    • use a 24-hour ambulatory ECG monitor in those with suspected asymptomatic episodes or symptomatic episodes less than 24 hours apart
    • use an event recorder ECG in those with symptomatic episodes more than 24 hours apart

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