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Atrial Fibrillation Tool

What Are Your Options?

This tool will provide you with a printout to take to your next doctor visit to help guide the discussion of the most appropriate treatment plan for your atrial fibrillation.

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Print these results and take them to your next doctor visit to help guide the discussion of the most appropriate treatment plan for your atrial fibrillation.

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When were you diagnosed with atrial fibrillation?

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Do you have persistent (continuous) atrial fibrillation?

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How frequent are your atrial fibrillation episodes?

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How long do your episodes last?

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Do you have any of these symptoms?

  • Heart palpitations - Sudden pounding, fluttering or racing sensation in the chest
  • Lack of energy - Feeling over-tired or decreased ability to perform your daily activities
  • Dizziness - Feeling light-headed or faint
  • Chest discomfort - Pain, pressure or discomfort in the chest
  • Shortness of breath - Having difficulty breathing during normal activities and even at rest
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Do you take medication for atrial fibrillation?

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Have you ever had a cardioversion?

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After the cardioversion, how long did normal rhythm last?

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Have you ever had an ablation for atrial fibrillation?

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When did you have an ablation?

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After the ablation, how long did normal rhythm last?

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Have you ever had surgery (i.e. Maze) for atrial fibrillation?

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How long ago did you have surgery (i.e. Maze)?

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After the surgery (i.e. Maze) how long did normal rhythm last?

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Do you have any of the following?

  • Coronary artery disease
  • Diabetes
  • Heart failure
  • History of stroke/TIA
  • Hypertension
  • Hypertrophic cardiomyopathy
  • ICD/Pacemaker
  • Open heart surgery
  • Valve disease
  • Congenital heart disease
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Is your ejection fraction normal?

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Has your doctor talked to you about anticoagulation (blood thinner) medication?

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Are you on any of the following anticoagulation medication?

  • Aspirin
  • Clopidogrel
  • Warfarin
  • Dabigatran
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Thank you for completing the questionnaire.

Download and print your responses for your next doctor visit.

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Contact Us

If you have additional questions or would like to schedule a consultation, please contact our team of heart and vascular resource nurses weekdays from 8:30 a.m. to 4:30 p.m. (EST).

Toll-free: 1.866.585.9150

You may find the following resources helpful:

To obtain an evaluation by a Cleveland Clinic electrophysiologist: Call Toll-free: 1.866.585.9150