Atrial fibrillation differential diagnosis

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Atrial fibrillation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Atrial fibrillation must be distinguished from other common atrial arrhythmias, which include atrial flutter, atrial tachycardia, paroxysmal supraventricular tachycardia, Wolff-Parkinson-White syndrome, and atrioventricular nodal reentry tachycardia.

Differentiating Atrial Fibrillation from other Diseases

Atrial fibrillation has to be differnetiated from other diseases like:

• Atrial flutter
• Atrial tachycardia
• Atrioventricular nodal reentry tachycardia (AVNRT)
• Multifocal atrial tachycardia
• Paroxysmal supraventricular tachycardia
• Wolff-Parkinson-White syndrome

The differentiating features are largely based on both EKG findings and cardiovascular examination.

• Atrial fibrillation is irregularly irregular, while the other rhythms such as atrial flutter, sinus tachycardia, AV nodal reentry tachycardia and paroxysmal supraventricular tachycardia are all much more regular.
• An atrioventricular nodal reentry tachycardia will often break with either carotid sinus massage or AV nodal blocking agents.
• If the patient has Wolff-Parkinson-White syndrome there may be much more rapid conduction. The presence of the delta wave on EKG is characteristic.

Arrhythmia	Rhythm	Rate	P wave	PR Interval	QRS Complex	Response to Maneuvers	Epidemiology	Co-existing Conditions
Atrial Fibrillation	Irregularly irregular		Absent, fibrillatory waves	Absent	Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction	Does not break with adenosine or vagal maneuvers		Old age, following bypass surgery, in mitral valve disease, hyperthyroidism
Atrial Flutter		75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) bpm, but 150 is more common	Sawtooth pattern of P waves at 250 to 350 beats per minute	Varies depending upon the magnitude of the block, but is short	Less than 0.12 seconds, consistent, and normal in morphology	Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm		More common in the elderly, after alcohol
Atrioventricular nodal reentry tachycardia (AVNRT)
Multifocal Atrial Tachycardia
Paroxysmal Supraventricular Tachycardia
Wolff-Parkinson-White Syndrome
Ventricular Fibrillation
Ventricular Tacycardia