| Evaluation procedures |
|---|
| History |
| 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 (i.e. hypertension, sleep apnea, left ventricular dysfunction, etc) |
| Take social history to identify potential triggers (i.e. 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 adverse effects |
| Physical Exam |
| Measure blood pressure and heart rate |
| Determine patient height and weight |
| Comprehensive precordial cardiac examination and assessment of jugular venous pressure, carotid and peripheral pulses to detect evidence of structural heart disease |
| Laboratory Investigations |
| Complete blood count, coagulation profile, renal function, thyroid and liver function |
| Fasting lipid profile, fasting glucose |
| 12-Lead Electrocardiogram |
| Document presence of AF |
| Assess for structural heart disease (myocardial infarction, ventricular hypertrophy, atrial enlargement, congenital heart disease) or electrical heart disease (Ventricular pre-excitation, 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 |
The identification of the etiology of AF during the initial investigation is particularly important for several reasons: