ECG patient diagnosis diagram

Uncontrolled Atrial Fibrillation (AF) should be referred to an Electrophysiologist

Diagram 1 - Simplified Patient Pathway 1- adapted from NICE guidance



Early Cardiology referral has been evidenced to improve clinical outcomes2. First-line treatment focuses on the use of anti-arrhythmic Drugs (AADs) or anticoagulants to control heart rate and rhythm, however this does not improve symptoms in all AF patients. Referral to cardiology and Electrophysiologists (Eps) is essential in patients who are unresponsive to initial treatment, present with severe symptoms such as HF, or those who are not tolerating anti-arrhythmic drugs well. Cardiology and EPs are able to utilise other treatment options such as ablation to improve symptoms.


Stroke icon​

20–30% of all strokes occur in people with Atrial Fibrillation.9

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Stroke as a complications of AF is associated with long-term disability and mortality.10

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AF Patients have a 142% increased risk of any stroke and a 133% greater risk of ischemic stroke9

Cardiology image​


Early Cardiology referral has been evidenced to improve clinical outcomes11. Electrophysiologists (EPs) are a subspecialist group of cardiology, growing in size and popularity more recently, specifically interested in Heart Rhythm Management, focussing on AF, Bradycardia and other cardiac arrhythmias or electrical circuitry pathologies. Referral to Cardiology and EPs is essential in patients who are unresponsive to initial treatment, present with severe symptoms such as HF or those who are not tolerating antiarrhythmic drugs well. EPs can offer a range of treatment, including ablation which is evidenced to improve symptoms with fewer side effects.11


Optimal Referral Pathway​

diagnosis of AF diagram

Diagram 2- adapted from Arrhythm Electrophysiol Rev. 2020 Jun 3; 9(1): 8–14.,doi 10.15420/aer.2019.06, PMCID: PMC7330726,PMID: 32637114 The Role of the Electrophysiologist in Convergent Ablation, Nadeev Wijesuriya, Nikos Papageorgiou, Edd Maclean, Bunny Saberwal, and Syed Ahsancor.​


Patient Symptoms​

Palpitations icon​
Fatigue icon​
Shortness of Breath icon​
Malaise icon​
Dizziness icon​
Anxiety icon​
Chest Pain icon​
Other icon​
5x increase heart failure graphic​
2.4x increase stroke graphic​
2x increase cardiovascular mortality graphic​

Patient Diagnosis​

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Patient History​

Pulse check icon​

Pulse Check​

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X-ray icon​

Echocardiogram & X-ray

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Blood Test​

AF Management and Risk​

Most AF patients are initially prescribed medications to restore their heart rhythm, manage the symptoms of AF, or minimize their risk of stroke. Medications may cause unwanted side effects and 48% of patient's treatment by antiarrhythmic drugs are unsuccessful.11

Anticoagulation icon​


Symptom management icon​

Better Symptom Management, including regular review​

Cardiovascular and Comorbidity Risk Management icon​

Cardiovascular and Comorbidity Risk Management

Af Rate Control Medications- Anticoagulation & Rate and Rhythm Management

Calcium Channel Blockers​

Interrupts the movement of calcium into the heart and blood vessel tissues to slow heart rate.​

Beta Blockers​

Slows heart rate, relaxes blood vessels and make it easier for the heart to pump blood.​

AF Rhythm Control Heart Medications​

Multiple rhythm control options exist, often influencing electrolyte balance within the heart to slow conduction and impact heart rhythm​

Sodium Channel Blockers

Slows the electrical conductivity of your heart to improve arrythmia.​

Antiarrhythmic Medication

Works to restore and/or maintain normal sinus rhythm.​

Anticoagulant Medication

Reduces the risk of blood clots and stroke.​

Three Main Types of AF

Paroxysmal AF icon​

Paroxysmal AF​

AF finishes spontaneously or by treatment within 7 days since the episode first began and may happen again.​

Persistent AF icon​

Persistent AF​

AF episode continues for more than 7 days and is unlikely to stop on its own.​

Permanent AF icon​

Permanent AF​

Patient and Healthcare Professional make a joint decision to stop attempts to restore or maintain the natural rhythm of the heart.​