Mandatory medical device diagnostics.
- VHF opportunity screening by pulse measurement and subsequent ECG, in patients ≥ 65 years of age (recommendation grade/evidence grade IB), and regular search for asymptomatic atrial high-frequency episodes (AHRE) in pacemaker patients (IB)Note: The US Preventive Services Task Force (USPSTF) does not make a recommendation on ECG screening for atrial fibrillation beginning at age 65 years, stating that current evidence is insufficient to evaluate the benefit-risk ratio of ECG screening for atrial fibrillation.
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) for diagnosis.
- [variable picture with more or less delineable atrial actions, often flicker waves expressing completely uncoordinated atrial excitation (no P waves)
- Absolute arrhythmia of the heart due to an irregular conduction (irregular RR intervals).
- QRS complexes narrow and normal shape.
- Atrial fibrillation is the most common form of supraventricular tachyarrhythmia (SVT) and the most common cause of irregular narrow complex tachycardia (QRS width ≤ 120 ms).
ECG recording over 72 hours captures approximately 92% of cases of atrial fibrillation]Note: Documentation of arrhythmia in an ECG is considered essential! (Class 1 recommendation).
- Transesophageal echocardiography (TEE; ultrasound examination of the heart by means of an ultrasound probe inserted into the esophagus) – before performing cardioversion (restoration of normal heart rhythm) to exclude thrombi (blood clots) in the atrium.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Long-term ECG
- For more accurate assessment of cardiac function within the day, event recorder if necessary.
- For detection of atrial fibrillation after cryptogenic stroke; ECG monitoring at least 72 hours, optimally over 30 days.
Further notes
- In ICD or pacemaker wearers without a history of atrial fibrillation, regular device interrogation should also be used to screen for atrial tachyarrhythmias, so-called AHRE (atrial high rate episode). If detected, screening measures should be used to try to detect atrial fibrillation.
- 6 Months after Catheter Ablation: the occurrence of ≥ 142 PACs (supraventricular complexes occurring >30% earlier than expected) per day at 6 months after catheter ablation was independently associated with a significantly increased risk (2.84 (95% confidence interval, 1.26-6.43), P=0.01) of late VHF recurrence.
