Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study
Abstract
Background Atrial fibrillation (AF) may occur without symptoms. Little is known about demographic features and prognostic information in patients with asymptomatic AF.Methods In the AFFIRM study, 4060 patients were randomized to either rhythm or rate control. At baseline, patients were identified as asymptomatic if they answered "no" to a 15-item questionnaire related to cardiac symptoms during AF in the 6 months before study entry.Results There were 481 (12%) asymptomatic patients at baseline. Compared with symptomatic patients, asymptomatic patients were more often men and had a lower incidence of coronary artery disease and congestive heart failure, but had more cerebrovascular events. Asymptomatic patients had a longer duration of AF, a lower maximum heart rate, and better left ventricular function. They received fewer cardiac medications and fewer therapies to maintain sinus rhythm. At 5 years, there was a trend for better survival in asymptomatic patients (81% vs 77%, P = .058), and they were more likely to be free from disabling stroke or anoxic encephalopathy, major bleeding, and cardiac arrest (79% vs 67%, P = .024). However, mortality and major events were similar after correction for baseline differences.Conclusions Patients with asymptomatic AF have less serious heart disease but more cerebrovascular disease. Asymptomatic patients receive different therapies than symptomatic patients. However, the absence of symptoms and the differences in treatment does not confer a more favorable prognosis when differences in baseline clinical parameters are considered. Anticoagulation should be considered in these patients.
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In patients with asymptomatic arrhythmias, relevant arrhythmias might not be adequately diagnosed and managed.
“Thus, in such patients, relevant arrhythmias might not be adequately diagnosed and managed.15”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [15]
Although cardiac rhythm disorders generally give rise to palpitations, in some subjects arrhythmias including prognostically relevant disorders such as non-sustained ventricular tachycardias and atrial fibrillation may remain completely asymptomatic.
“It is important to underline the fact that, although cardiac rhythm disorders generally give rise to palpitations (or other related symptoms, such as fatigue, dyspnoea, dizziness, syncope, and angina), in some subjects, for reasons not entirely known but probably linked to some clinical characteristics (long-standing arrhythmias with relatively low maximum ventricular rate, male sex, absence of”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [15]
Palpitations due to arrhythmias, in particular of ventricular origin, but also atrial fibrillation, are associated with different prognostic implications.
“On the one hand, depending on the clinical characteristics of the patient, palpitations due to arrhythmias, in particular of ventricular origin, but also atrial fibrillation, are associated with different prognostic implications.15 -17”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [15]
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- Authors
- Flaker, G. C., Belew, K., Beckman, K., Vidaillet, H., Kron, J., Safford, R., Mickel, M., & Barrell, P.
- Affiliations
- University of Missouri (US)
- University of Oklahoma Health Sciences Center (US)
- Oregon Health & Science University (US)
- Mayo Clinic in Florida (US)
- Corresponding author
- Flaker, Greg C.
- ORCID
- Safford, Robert
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2005-04
- Volume
- 149
- Issue
- 4
- Pages
- 657-663
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W1977819036
- Cited by
- 341
- References
- 23
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 25 · 2023: 9 · 2022: 23 · 2021: 21 · 2020: 18 · 2019: 18 · 2018: 17 · 2017: 24 · 2016: 26 · 2015: 21 · 2014: 26 · 2013: 15 · 2012: 15
- FWCI
- 7.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc055139-000)
- National Heart, Lung, and Blood Institute (N01-HC-55139)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- asymptomatic atrial fibrillation, atrial fibrillation, prognosis, demographic factors, rhythm control, rate control, stroke, major bleeding, cardiac arrest, anticoagulation, left ventricular function, atrial fibrillation duration, AFFIRM trial
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Cause of Death, Cerebrovascular Disorders, Coronary Disease, Electric Countershock, Female, Follow-Up Studies, Heart Arrest, Heart Failure, Hemorrhage, Humans, Male, Middle Aged, Prognosis, Quality of Life, Socioeconomic Factors, Comorbidity, Incidence, Survival Analysis, Treatment Outcome, Ventricular Dysfunction, Left
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