Why everyone with Afib should have an echocardiogram

An echocardiogram is an ultrasound-based assessment of the heart. 

It is painless, harmless, readily available in most hospitals and can give a large amount of very useful information about the structure and function of the heart. 

As atrial fibrillation can be caused by a structural problem with the heart such as heart valve disease or heart muscle weakness, the echo can help to elucidate the underlying cause of the AF. 

Secondly, the echo can help assess the size of the atria. If the atria look very enlarged then it makes it more unlikely that the heart can be restored to a normal rhythm. 

Thirdly, one important risk factor for strokes in patients with AF is the presence of heart failure. The echo can easily identify if the heart is weak and therefore help with risk assessment.

Fourthly, sometimes when the heart rate is excessively fast due to AF and not adequately controlled, the heart itself can start weakening. This is called a tachycardia-induced cardiomyopathy. The echo can identify a tachycardia induced cardiomyopathy and therefore guide appropriate treatment. The good news is that with appropriate rate control treatment, a tachycardia induced cardiomyopathy can easily be reversed.

Finally, some heart rhythm control medications such as Flecainide should not be used in patients with structural heart disease. A normal echocardiogram is reassuring with this regard and allows such medications to be used.

Here is a video I have completed on this subject


About the Author:

I'm Dr Sanjay Gupta, a Consultant Cardiologist with specialist interest in Cardiac Imaging at York Teaching Hospital in York, UK. I believe that high quality reliable jargon-free information about health should be available at no cost to everyone in the world.


  1. Rob 5th August 2019 at 11:21 pm - Reply

    Hi Sanjay…you’re a Saint with the work you do on Afib youtubes..I’ve just paid for an echo and your LV vid explained it all brilliantly which reduces any anxieties..I’m in ongoing Afib so the and right atria were logically dilated but otherwise your vid. explanation showed everything else was normal..I can’ t seem to find your followup RV echo vid…can you be so kind as to dirrct me to it, please?… keep up the good work..good karma 🎅😊😎

  2. Michelle finbow 11th April 2021 at 6:26 pm - Reply

    Thank you for this I have just paid to have one done and awaiting report, my GP refused for me to have one on NHS saying ecg was satisfactory, even though I am sure my symptoms are AF, along with ventricular and super ventricular ectopics

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