GPAtlas🧭 When to suspect
Atrial fibrillation (AF) is the commonest sustained arrhythmia.
• Suspect AF whenever you find an irregularly irregular pulse, or in anyone with palpitations, breathlessness, dizziness, chest discomfort or fatigue.
• Many people are asymptomatic.
• AF is often found incidentally – for example when checking the pulse before a blood pressure reading – or only after a complication such as stroke/TIA or heart failure.
Diagnosis is electrical, not clinical.
• An irregular pulse is the trigger to record a 12-lead ECG, which shows absent P waves and an irregularly irregular QRS.
• A single normal ECG does not exclude paroxysmal AF – if symptoms are intermittent, arrange ambulatory monitoring.
• Atrial flutter is assessed and anticoagulated along the same lines as AF.
The three primary-care tasks are best remembered as the ABC pathway: Anticoagulation to avoid stroke (the priority), Better symptom control (usually rate control), and Comorbidity and cardiovascular-risk management.
| Pattern | Definition |
|---|---|
| Paroxysmal | Self-terminating, usually within 48 hours and by definition within 7 days |
| Persistent | Continuous for > 7 days, or requires cardioversion to terminate |
| Long-standing persistent | Continuous for > 12 months when a rhythm-control strategy is still being pursued |
| Permanent | • AF accepted • No further attempts to restore sinus rhythm |
Stroke risk is the same whatever the pattern – asymptomatic and paroxysmal AF are not low-risk AF, and the anticoagulation rules apply equally.
Source: NICE NG196
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