Patients who are suspected of having atrial fibrillation should obtain an electrocardiogram to establish the diagnosis. On the ECG it should show rapid baseline waves, absence of the P wave, and irregularly irregular ventricular response. A transthoracic echocardiogram should be obtained to rule out any vavular disease pericardial disease. To determine the correct management of the patients a fib the following factors must be taken into consideration: hemodynamic stability, concurrent cardiovascular symptoms, identifying contributing factors, and duration of atrial fibrillation. A chest x-ray may be used if there is any suspected pulmonary abnormality. The x-ray is used to detect enlargement or the chambers, and evaluate pulmonary