慢性心房颤动

心律失常发作时心电图至少一个导联记录到心房颤动方可诊断。[1]Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011 Mar 15;123(10):e269-367.http://circ.ahajournals.org/content/123/10/e269.fullhttp://www.ncbi.nlm.nih.gov/pubmed/21382897?tool=bestpractice.com[2]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962.https://academic.oup.com/eurheartj/article/37/38/2893/2334964http://www.ncbi.nlm.nih.gov/pubmed/27567408?tool=bestpractice.com该检查在发现持续性房颤方面非常准确。然而，当诊断不确定或室率控制需要进一步评估时，可能还需要采用 24 小时（或者甚至 7 天）动态心电图监测或事件记录仪（例如 Cardiomemo）。[15]National Institute for Health and Care Excellence. Atrial fibrillation: management. June 2014 [internet publication].https://www.nice.org.uk/guidance/cg180/[Figure caption and citation for the preceding image starts]: 心房颤动：P波不可辨，心室率（QRS波群）无规律，且节律不齐由Arti N. Shah医生提供 [Citation ends].

低振幅的P波，如房性心动过速尤其是多源性房性心动过速可能在慢性阻塞性肺病患者中出现并有可能与心房颤动相似。

对于装有永久心脏起搏器的患者，心电图检查可能会漏诊潜在的心房颤动，尤其当伴有快速起搏心室率时。

P波消失；出现大小、形状和时间不同的纤维性颤动波；QRS波群无规律性出现且节律不齐

甲状腺功能亢进可能会导致出现心房颤动。 甲状腺功能亢进可以由实验室诊断，并以药物、放射治疗或手术进行适当治疗。 当心室率难以控制时，诊断其是否为甲状腺毒症同样重要。[1]Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011 Mar 15;123(10):e269-367.http://circ.ahajournals.org/content/123/10/e269.fullhttp://www.ncbi.nlm.nih.gov/pubmed/21382897?tool=bestpractice.com[2]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962.https://academic.oup.com/eurheartj/article/37/38/2893/2334964http://www.ncbi.nlm.nih.gov/pubmed/27567408?tool=bestpractice.com[15]National Institute for Health and Care Excellence. Atrial fibrillation: management. June 2014 [internet publication].https://www.nice.org.uk/guidance/cg180/

甲状腺功能亢进时TSH水平受抑制

超声心动图对排除重要的心脏病因及持续性心房颤动的危险因素十分重要，如瓣膜病和心包疾病，以及心肌病。

和经胸超声心动图相比，经食道超声心动图更能准确的检测左心房的血栓。[1]Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011 Mar 15;123(10):e269-367.http://circ.ahajournals.org/content/123/10/e269.fullhttp://www.ncbi.nlm.nih.gov/pubmed/21382897?tool=bestpractice.com[2]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962.https://academic.oup.com/eurheartj/article/37/38/2893/2334964http://www.ncbi.nlm.nih.gov/pubmed/27567408?tool=bestpractice.com所有需要转复，而抗凝状态未知或不充分的患者，都应该首先进行经食道超声心动图排除左心房血栓。

可能发现瓣膜返流或狭窄、左心室或心房肥大、右心室压力增高（肺动脉高压）、左心室壁厚度和功能异常

检查作为肾功能指标的血清肌酐很重要， 这将影响后续的治疗以及药物的选择和剂量。

可能正常；肾功能不全时可能异常

肝酶可能因酗酒而异常，这也是心房颤动的危险因素。

也有助于选择抗心律失常药物及其剂量。

有可能正常或紊乱

诊断不明确时，行超过 24 小时（或甚至 7 天）的心电图检查对诊断很有帮助。可能需要一个事件记录仪（例如 Cardiomemo），还可能需要插入式/植入式心电记录器。[15]National Institute for Health and Care Excellence. Atrial fibrillation: management. June 2014 [internet publication].https://www.nice.org.uk/guidance/cg180/[49]Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014 Jun 26;370(26):2467-77.http://www.nejm.org/doi/full/10.1056/NEJMoa1311376#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963566?tool=bestpractice.com[50]Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun 26;370(26):2478-86.http://www.nejm.org/doi/full/10.1056/NEJMoa1313600#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963567?tool=bestpractice.com

可检测心房颤动的发作