Atrial fibrillation electrocardiogram

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File:Critical Pathways.gif

Sinus rhythm
Heart conduct sinus.gif
Atrial fibrillation
Heart conduct atrialfib.gif

Atrial Fibrillation Microchapters


Patient Information


Historical Perspective




Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Pulmonary Diseases
ACS and/or PCI or valve intervention
Heart failure


History and Symptoms

Physical Examination

Laboratory Findings


EKG Examples
A-Fib with LBBB

Chest X Ray


Holter Monitoring and Exercise Stress Testing

Cardiac MRI


Rate and Rhythm Control


Electrical Cardioversion
Pharmacological Cardioversion


Converting from or to Warfarin
Converting from or to Parenteral Anticoagulants

Maintenance of Sinus Rhythm


Catheter Ablation
AV Nodal Ablation
Surgical Ablation
Cardiac Surgery

Specific Patient Groups

Primary Prevention

Secondary Prevention

Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]


Atrial fibrillation is diagnosed with the electrocardiogram, an investigation performed routinely whenever irregular heartbeat is suspected. Characteristic findings are the absence of P waves, with unorganized electrical activity in their place, and irregularity of R-R interval due to irregular conduction of impulses to the ventricles. If paroxysmal atrial fibrillation is suspected and 12-lead ECG is normal, usage of a 24-hour ambulatory ECG monitor is recommended. Typical electrocardiogram findings in a patient with atrial fibrillation are absent P waves, irregularly irregular ventricular response rate, and an atrial rate that ranges from 400 to 700 BPM. A rapid, irregular, sustained, wide-QRS-complex tachycardia strongly suggests atrial fibrillation (AF) with conduction over an accessory pathway or atrial fibrillation (AF) with underlying bundle-branch block.


Summary of Electrocardiographic Findings

When are Electrocardiograms Used for Screening?

The SAFE trial found that electronic software, primary care physicians and the combination of the two had the following sensitivities and specificities:[5]

If paroxysmal atrial fibrillation (AF) is suspected but the electrocardiogram shows a regular rhythm, episodes may be documented with the use of Holter monitoring (continuous ECG recording for 24 hours). If the symptoms are very infrequent, longer periods of continuous monitoring may be required.[3]

Shown below is an ECG showing rapid ventricular response (short R-R interval) and no P waves suggestive of atrial fibrillation.

AFIB 01 jpg.jpg

Copyleft image obtained courtesy of ECGpedia,

Shown below is an ECG showing a rapid ventricular rate (short R-R interval) and no P waves suggestive of atrial fibrillation.

AFIB 02.jpg

Copyleft image obtained courtesy of ECGpedia,

Shown below is an ECG showing absent P waves with a slow ventricular response suggestive of atrial fibrillation.

AFIB 03.jpg

Copyleft image obtained courtesy of ECGpedia,

Shown below is an ECG showing absent P waves throughout the precordium, suggestive of atrial fibrillation.

AFIB 04.jpg

Copyleft image obtained courtesy of ECGpedia,

For more ECG examples of atrial fibrillation click here.

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[6]

  • Irregular R-R intervals (when atrioventricular conduction is present)
  • Absence of distinct repeating P waves
  • Irregular atrial activity

Clinical Evaluation

Class I
"1. Electrocardiographic documentation is recommended to establish the diagnosis of AF. (Level of Evidence: C) "



  1. Tse HF, Newman D, Ellenbogen KA, Buhr T, Markowitz T, Lau CP; et al. (2004). "Effects of ventricular rate regularization pacing on quality of life and symptoms in patients with atrial fibrillation (Atrial fibrillation symptoms mediated by pacing to mean rates [AF SYMPTOMS study])". Am J Cardiol. 94 (7): 938–41. doi:10.1016/j.amjcard.2004.06.034. PMID 15464683.
  2. Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check |pmid= value (help).
  3. 3.0 3.1 Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R (2004). "Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack". Stroke. 35 (7): 1647–51. doi:10.1161/01.STR.0000131269.69502.d9. PMID 15155965.
  4. Perez MV, Dewey FE, Marcus R, Ashley EA, Al-Ahmad AA, Wang PJ; et al. (2009). "Electrocardiographic predictors of atrial fibrillation". Am Heart J. 158 (4): 622–8. doi:10.1016/j.ahj.2009.08.002. PMID 19781423.
  5. Mant J, Fitzmaurice DA, Hobbs FD; et al. (2007). "Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial". doi:10.1136/bmj.39227.551713.AE. PMID 17604299.
  6. 6.0 6.1 January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.

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