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Atrial Fibrillation and Atrial Flutter G011

Last amended 
10 January 2023
Current RMA Instruments
Reasonable Hypothesis SOP
1 of 2023
Balance of Probabilities SOP
2 of 2023
Changes from previous Instruments

SOP Bulletin 234

ICD Coding
  • ICD-10-AM Code: I48

Brief description

This SOP covers two related types of disturbance of the electrical rhythm of the heart (arrhythmia).  Atrial fibrillation is characterised by rapid, irregular, disorganised atrial contractions.  In atrial flutter the atrial contractions are regular but rapid and inefficient.  Both may be paroxysmal (intermittent) or persistent.  Atrial fibrillation may convert to atrial flutter and vice versa.

Confirming the diagnosis

This diagnosis is made on the basis of findings on electrocardiography (ECG).

The relevant medical specialist is a cardiologist.

Additional diagnoses that are covered by this SOP
  • AF [Atrial Fibrillation]
Conditions excluded from SOP
  • PAT [paroxysmal atrial tachycardia]
  • Ventricular dysrhythmias.
Clinical onset

Once the diagnosis has been confirmed by ECG it may be possible to back date onset to when relevant symptoms (particularly palpitations) first started.  Other symptoms that may be due to AF are non-specific and generally won't allow a clinical onset to be established.

Clinical worsening

The natural history of intermittent (paroxysmal) atrial fibrillation is for episodes to continue with a variable frequency and for progression to permanent AF to occur in a proportion of subjects.  In some cases the AF may resolve with treatment of an underlying cause.  It is difficult to envisage how permanent AF can be worsened per se.  The development of consequences such as a CVA (cerebrovascular accident) represents the onset of a new disease/injury rather than worsening of AF.