How to assess atrial fibrillation (afib) radial pulse?

From the Guidelines

To assess atrial fibrillation (AFib) through a radial pulse, it is crucial to use electrocardiogram (ECG) documentation as the diagnostic standard, as recommended by the 2024 ESC guidelines 1. When assessing the radial pulse, place your index and middle fingers on the patient's radial artery at the wrist, just below the thumb. Press gently until you feel the pulse.

Key Characteristics of AFib on Pulse Examination

• Irregularity and variability in pulse strength
• "Irregularly irregular" pattern with no discernible pattern to the irregularity
• The strength of individual beats may vary significantly
• Pulse deficit, where the heart rate counted at the radial pulse is lower than that heard over the heart with a stethoscope However, it is essential to confirm any suspected AFib with an ECG, as this is the definitive diagnostic tool, with a standard 12-lead ECG recording or a single-lead ECG tracing of ≥30 s showing heart rhythm with no discernible repeating P waves and irregular RR intervals 1.

Importance of ECG Confirmation

• ECG documentation is required to establish the diagnosis of AF, as stated in the 2024 ESC guidelines 1
• Confirmation by an electrocardiogram (12-lead, multiple, or single leads) is recommended to establish the diagnosis of clinical AF and commence risk stratification and treatment 1 Pulse assessment is valuable for screening and monitoring but cannot replace electrocardiographic confirmation for diagnosis.

Additional Considerations

• Evaluate AF-related symptoms (including fatigue, tiredness, exertional shortness of breath, palpitations, and chest pain) and quantify the patient symptom status using the modified EHRA symptom scale before and after initiation of treatment, as recommended by the 2024 ESC guidelines 1
• Consider comorbidity and risk factor management, such as good BP control, weight loss, and reducing alcohol consumption, to reduce AF recurrences and risk of stroke and bleeding 1

From the Research

Assessing Afib Radial Pulse

To assess afib radial pulse, it is essential to understand the condition and its treatment. Atrial fibrillation (afib) is a type of irregular heartbeat that can lead to various complications, including stroke and heart failure. The radial pulse is often used to assess heart rate and rhythm.

Treatment Options

Several treatment options are available for afib, including:

• Beta-blockers: These medications can help slow the heart rate and reduce symptoms 2, 3, 4.
• Non-dihydropyridine calcium channel blockers (NDCC): These medications can also help slow the heart rate and reduce symptoms 2, 3, 4.
• Digoxin: This medication can help slow the heart rate, but it is generally less effective in acute settings 5.

Assessing Radial Pulse

When assessing the radial pulse in patients with afib, it is crucial to consider the following:

• Heart rate: The heart rate should be assessed to determine if it is within a normal range (usually between 60-100 beats per minute) 4.
• Rhythm: The rhythm should be assessed to determine if it is regular or irregular 5.
• Symptoms: The patient's symptoms should be assessed to determine if they are experiencing any discomfort or pain 2, 3.

Safety and Efficacy

The safety and efficacy of treatment options for afib should be considered when assessing the radial pulse. For example:

• Beta-blockers and NDCC have been shown to be effective in controlling heart rate and reducing symptoms in patients with afib 2, 3, 4.
• However, NDCC should be used with caution in patients with heart failure with reduced ejection fraction, as they may worsen symptoms 3, 6.