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Pulse-checking is recommended in patients who present with common symptoms of AF including:1,2

  • Palpitations
  • Shortness of breath
  • Light-headedness
  • Fainting
  • Fatigue
  • Chest pain

However, the symptoms of AF are highly variable – if present at all,3,4 – and so active screening is also recommended.5 Opportunistic screening for AF is recommended in patients aged >65 years, using either an electrocardiogram (ECG) or pulse-checking with follow-up ECG.6

Appropriate patients may be educated to monitor their own pulse – download the Know Your Pulse leaflet to support this.

A range of hand-held devices and smartphone apps, recommended by NICE, are also available to support patients with self-monitoring.

Pulse-checking for an irregular pulse has been found to have 94% sensitivity and 72% specificity in the detection of AF.7 Therefore, if an irregular pulse is detected, NICE guidelines recommend an ECG is performed whether patients are symptomatic or not.2

This guide details how to diagnose AF using an ECG.

As detailed in the guide, prolonged or repeated ECG recordings may be necessary to diagnose AF in some patients such as those with suspected paroxysmal AF.2,6

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Abbreviations

AF = Atrial Fibrillation ECG = Electrocardiogram NICE = National Institute for Health and Care Excellence

References
  1. Atrial Fibrillation Association. Atrial Fibrillation: Preventing a Stroke Crisis, 2011. Available at: http://atrialfibrillationassociation.org.uk/app/webroot/files/file/140508-cw-FINAL-The%20AF%20Report.pdf. Accessed August 2019.
  2. NICE. CG180. 2014. Available at: https://www.nice.org.uk/guidance/cg180. Accessed August 2019.
  3. Xiong Q et al. Int J Cardiol 2015; 191:172–177.
  4. Rienstra M et al. Circulation. 2012; 125: 2933–2943.
  5. Fitzmaurice DA, et al. BMJ 2007; 3355: 383.
  6. Kirchhof P et al. Eur Heart J 2016; 37: 2893–2962.
  7. Cooke G et al. J Fam Pract 2006; 55: 130–134.

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Job code: 432UK1900440-01
Date of preparation: September 2019

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