- Document type
- Clinical pathways
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Pathways
- Pathway
- Confirmed AF PathwaySuspected AF Pathway
Atrial Fibrillation (AF)
Pathway published: April 2023.
Next review date: April 2025.
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)