How Atrial Fibrillation Is Diagnosed

Reviewed by Brunilda Nazario, MD on February 19, 2021

Atrial fibrillation, or AFib, may or may not cause symptoms. Your doctor could find it during a regular physical. Or you might make an appointment after you notice signs like a fluttering heartbeat or fatigue.

If your doctor thinks you have it, the first thing they’ll do is listen to your heart. They may be able to hear your irregular heartbeat with a stethoscope. If not, they may ask for tests to confirm the diagnosis, find out what's causing it, and figure out the best way to treat it.

Sometimes your primary care or family doctor is the one who diagnoses AFib. But your doctor may refer you to a:

  • Cardiologist, a doctor who specializes in heart diseases and conditions
  • Electrophysiologist, a doctor who specializes in arrhythmias

Doctor Exam

When you make an appointment with your doctor or the specialist to see if you might have atrial fibrillation, ask if you need to do anything to prepare. You may need to follow a special diet before blood tests, for example.

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To make the most of your time with the doctor, be ready to describe your symptoms and when they happen. Make a list of medications you take, including supplements and over-the-counter medicines. And be prepared with information about your health history and that of close family members.

Take note of any questions you have for your doctor, such as:

  • What could be causing my symptoms?
  • What kind of tests will I need?
  • What are the recommended treatments for my condition? Are there any effective alternatives?
  • Do I need to make changes to my lifestyle?

During your exam, the doctor will ask detailed questions about your:

  • Symptoms
  • Health habits
  • Health problems
  • Family medical history

During the physical exam, they are likely to:

  • Listen to your heartbeat's rate and rhythm
  • Take your pulse and blood pressure
  • Listen to your lungs

Does AFib Show Up on an Electrocardiogram (EKG)?

Yes. This simple, painless test is the most helpful to diagnose AFib. It records your heart's electrical activity. It can show the:

  • Speed of your heartbeat
  • Rhythm of your heartbeat
  • Strength and timing of electrical signals passing through your heart

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A doctor or technician places small patches, called electrodes, on different areas of your body, including several on your chest. These pick up signals that make wave patterns on the EKG results. It gives your doctor a picture of your heart's overall electrical activity.

But because the test is a quick snapshot, a standard EKG won't always catch AFib. Sometimes you'll need a portable heart rhythm monitor to keep tabs on your ticker over a longer time.

Holter Monitor

You keep this device with you for 24 to 48 hours while it continuously records your heart's electrical activity. The extra time gives a better chance of picking up an abnormal heart rhythm, what doctors call an arrhythmia.

Just as with a regular EKG, you'll have small electrodes attached to your chest. Wires connect these electrodes to a small recorder you can clip onto a belt, keep in a pocket, or hang around your neck.

Then you just go about doing what you usually do. Your doctor will check the recorded results later.

Event Monitor

This works like a Holter monitor, but it records your heart's activity only at certain times, usually for a 30-day period. It might automatically start recording when it senses something is off. Or you might have to push a button when you feel:

  • Dizzy
  • Weak
  • Lightheaded
  • A racing or fluttering heart

You may need to wear it for a month or so -- as long as it takes to catch and record the trouble.

Mobile Cardiac Telemetry (MCT)

You might hear this called mobile cardiac monitoring. You wear this small device 24/7, and it monitors your heart as you go about your daily life. Most send a Bluetooth signal to a data center, which analyzes the info and gives your doctor a report.

Stress Test

It's just what it sounds like: A test that puts extra stress on your heart to see how it responds to working hard and beating fast. You'll be hooked up to an EKG during the test, and the technician will watch your heart rate and blood pressure, too.

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Exercise is an easy way to get your heart pumping. You might ride a stationary bicycle, or walk or run on a treadmill. That's why this is sometimes called a treadmill test.

If your body can't handle intense activity, you can take a special medicine that makes your heart beat faster instead.

Echocardiogram

This test uses sound waves and a computer to create a moving picture of your heart. An echo gives your doctor information about:

  • The size and shape of your heart
  • How well the heart muscle and valves are working
  • Where the heart muscle isn't contracting the right way

Transthoracic echocardiogram (TTE). This imaging test gives your doctor a picture of your heart. The doctor uses a device called an ultrasound transducer to give off and read sound waves that bounce off the walls and valves in your heart. A computer uses the data to create a video of your heart. Your doctor can see the size of your heart, how well it’s working, how well your heart valves are working, and if you have any blood clots.

Transesophageal echocardiogram (TEE). This imaging test gives the doctor a picture of your heart. They’ll place a probe down your esophagus (the tube that connects your mouth to your stomach). It goes right behind your heart. Once the probe is in place, it works the same way as a TTE.

Blood Tests

These can point your doctor to what might be causing your AFib. Blood tests may check for infection, thyroid and kidney problems, signs of a heart attack, and more.

Portable Electrocardiogram

You might hear this called a handheld EKG. Or it could look like a wristwatch. It has electrodes on the back that take your pulse at your chest or your wrist. You can get one from a discount store, drugstore, or online. The doctor may suggest you do it so you can take a quick reading when you feel something. It’ll store your EKG data in its memory for your doctor to read.

Fitness Trackers

Popular smartwatches outfitted with special sensors called photoplethysmographic sensors (or PPGs) can detect AFib.

Electrophysiology Study

An electrophysiology study (EPS) can help your doctor understand what's causing your abnormal heartbeat and figure out the best way to treat it.

In this operation, your cardiologist inserts a thin, flexible electrode into a blood vessel leading to your heart, usually in your neck or groin. They then use an imaging system to guide the electrode to your heart. Once there, the electrode can measure your heart's electrical signals.

Your doctor will give you a numbing medication before the surgery to keep you from feeling pain. You might also get a sedative to help relax you. The procedure may take 1-4 hours, and you'll rest in a recovery room for 4-6 hours after that.

WebMD Medical Reference

Sources

SOURCES:

National Heart, Lung, and Blood Institute: “Atrial Fibrillation,” "How is Atrial Fibrillation Diagnosed?"

American Heart Association: “Cardiac Event Recorder,” "Common Tests for Arrhythmia."

Northwestern Memorial Hospital: "Atrial Fibrillation Express Test."

Medscape: "Atrial Fibrillation Workup: Lab Studies."

Medical Devices: Evidence and Research.

Heart Rhythm Society: “Artificial Intelligence Automatically Detects Atrial Fibrillation Using Apple Watch’s Heart Rate Sensor,” “Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors,” “Diagnosing Atrial Fibrillation (AFib),” “New Study Show Popular Smart Watches Accurately Measure Rapid Heart Beat.”

Current Treatment Options in Cardiovascular Medicine: “Role of Magnetic Resonance Imaging in Atrial Fibrillation Ablation.”

Heart Rhythm: “2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry.”

Mayo Clinic: “Tilt table test,” "Atrial fibrillation," "EP study."

iproc: “Screening of Atrial Fibrillation Using Wrist Photoplethysmography from a Fitbit Tracker.”

Johns Hopkins Medicine: "Electrophysiologial Studies."

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