{"id":128964,"date":"2023-01-09T17:02:37","date_gmt":"2023-01-09T17:02:37","guid":{"rendered":"https:\/\/ccs.ca\/?post_type=guideline&p=128964"},"modified":"2023-04-19T07:47:57","modified_gmt":"2023-04-19T07:47:57","slug":"chapter-4-clinical-evaluation","status":"publish","type":"guideline","link":"https:\/\/ccs.ca\/fr\/guideline\/2020-atrial-fibrillation\/chapter-4-clinical-evaluation\/","title":{"rendered":"4. Clinical Evaluation"},"content":{"rendered":"\n
The purpose of the initial evaluation of a patient with AF is to establish the magnitude and severity of symptoms attributable to AF, identify the underlying etiology and precipitants of AF, establish prognosis, and develop a therapeutic strategy for symptom relief and morbidity mitigation (Fig. 4).<\/p>\n\n\n\n
A comprehensive AF history should include the date of first symptomatic attack as well as the date of first ECG documentation. For patients in AF at the time of assessment, the timing of onset for the current AF episode should be determined. The duration and frequency of episodes should be used to establish the predominant pattern of AF (paroxysmal vs persistent; see section 1). Of note, in some cases the symptom evaluation might be insufficient for the determination of AF pattern and additional monitoring might be required.[12]<\/a>,[13]<\/a><\/sup> The presence and nature of AF-related symptoms, their severity, and their effect on QOL should be determined (see section 4.3). Symptoms might be absent or manifest as palpitations, dyspnea, dizziness, weakness, fatigue, or chest pain.[67]<\/a><\/sup> In addition, it is important to elicit any history of regular palpitations because any supraventricular tachycardia (SVT) can lead to the development of AF, and ablation of the SVT might eliminate or substantially reduce the likelihood of recurrent AF (see section 11.7).[68]<\/a>,[69]<\/a><\/sup> Symptoms at the termination of AF episodes, such as presyncope or syncope, should be determined because significant sinus pauses might limit the use of rate- or rhythm-controlling medications and might require the use of permanent pacing or prompt early ablation. Precipitating factors (\u201ctriggers for AF episodes\u201d), reversible causes, and coexisting cardiovascular risk conditions should be determined. These include modifiable cardiovascular risk factors and comorbid conditions, which if treated, might reduce or eliminate AF recurrence and improve the overall outcome of the patient, independent of AF (see section 6).[32]<\/a>,[70]<\/a><\/sup> Past evaluations and treatments should be explored, including a record of all previous pharmacologic and nonpharmacologic AF interventions (eg, cardioversion and catheter ablation). AF-related health care utilization should be documented, including a record of emergency department (ED) visits, hospital admissions, and cardioversions. Risk factors for stroke (see section 8.1) and bleeding (see section 8.5.1) should be elicited. The precise frequency, duration, and intensity of sports participation (current and previous) needs to be assessed carefully for all AF patients (see section 11.3). In addition, the evaluation should include: a comprehensive review of all prescription, over the counter, and nonprescription medications; a social history with a focus on alcohol, tobacco, and recreational drug intake; and a family history of cardiac dysrhythmia or relevant risk conditions.<\/p>\n\n\n\n