| Evaluation procedures |
|---|
| History and physical examination |
| Establish pattern (new onset, paroxysmal, persistent, or permanent) |
| Establish severity (including impact on quality of life) Identify etiology |
| Identify reversible causes (hyperthyroidism, ventricular pacing, supraventricular tachycardia, exercise, etc) |
| Identify risk factors whose treatment could reduce recurrent AF or improve overall prognosis (ie, hypertension, sleep apnea, left ventricular dysfunction, etc) |
| Take social history to identify potential triggers (ie, alcohol, intensive aerobic training, etc) |
| Elicit family history to identify potentially heritable causes of AF (particularly in lone AF) |
| Determine thromboembolic risk |
| Determine bleeding risk to guide appropriate antiplatelet or antithrombotic therapy |
| Review prior pharmacologic therapy for AF, both for efficacy and for adverse effects |
| Measure blood pressure and heart rate |
| Determine patient height and weight |
| Comprehensive precordial cardiac examination and assessment of jugular venous pressure and carotid and peripheral pulses to detect evidence of structural heart disease |
| 12-Lead electrocardiogram |
| Document presence of AF by electrocardiography |
| Assess for structural heart disease (myocardial infarction, ventricular hypertrophy, atrial enlargement, congenital heart disease) or electrical heart disease (ventricular preexcitation, Brugada syndrome) |
| Identify risk factors for complications of therapy for AF (conduction disturbance, sinus node dysfunction, or repolarization); document baseline PR, QT, or QRS intervals |
| Echocardiogram |
| Document ventricular size, wall thickness, and function |
| Evaluate left atrial size (if possible, left atrial volume) |
| Exclude significant valvular or congenital heart disease (particularly atrial septal defects) |
| Estimate ventricular filling pressures and pulmonary arterial pressure |
| Complete blood count, coagulation profile, renal, thyroid, and liver function |
| Fasting lipid profile, fasting glucose |
The identification of the etiology of AF during the initial investigation is particularly important for several reasons: