RAG rating

n/a

Document type

Clinical pathways

Place

Hertfordshire and West Essex ICB

Output type

Clinical Pathways

Pathway

Confirmed AF Pathway | V7 February 2026Suspected AF Pathway

Atrial Fibrillation (AF)

 

 Suspected Atrial Fibrillation

Either incidental finding on ECG or clinical finding of irregularly irregular pulse

• Conduct cardio vascular examination, assess for red flags (see pathway for details)
• Perform ECG
  
  
  The following patients should be referred to emergency care

• Pulse >150 beats/minute and/or low BP (systolic <90mmHg)
• Loss of consciousness, chest pain, severe shortness of breath
• Complication of AF (stroke, TIA, acute CCF)
  
  

If ECG does not show AF:

• Sinus rhythm but paroxysmal AF still suspected à consider differentials and ambulatory monitoring (see pathway for details)
• Non-AF arrhythmia identified à consider if cardiology referral appropriate
  
  

If ECG confirms AF:

Persistent AF likely (lasts longer than 7 days or requires termination by cardioversion)

• Assess in primary care for underlying causes (see pathway for details)
• Start symptomatic management in primary care, even if referred to cardiology
• Consider if rate or rhythm control needed (see pathway for details)
• Consider risks and benefits of anticoagulation
• Consider need for echo
• Consider referral to cardiology (see pathway for referral criteria and advice)
• Review medication and continue to reduce stroke risk
  
  

Paroxysmal AF likely (usually terminates within 48h)

• Referral to cardiology recommended for this group (see pathway for details)
• Consider risks and benefits of anticoagulation
• Consider starting rate control medication whilst waiting for cardiology appointment (see pathway for details)