Cited by 342Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementCardiac pacing and defibrillation studies

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Asymptomatic atrial fibrillation: Demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study

Flaker, Greg C., Belew, Kathy, Beckman, Karen, Vidaillet, Humberto, Kron, Jack, Safford, Robert, Mickel, Mary, Barrell, Patrick·2005·American Heart Journal

DOI 10.1016/j.ahj.2004.06.032

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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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BackgroundResultInfluential
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Predictors of Long-term Success After Concomitant Surgical Ablation for Atrial Fibrillation
Pecha, S., Ghandili, S., Hakmi, S., Willems, S., Reichenspurner, H. C., & Wagner, F. (2017) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2017.08.015 · Cited by 14
Prognostic Impact of the Symptom of New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Insights From the NOAFCAMI-SH Registry
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Epidemiología de la fibrilación auricular y comorbilidades asociadas
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The Influence of Symptoms and Device Detected Atrial Tachyarrhythmias on Medical Management: Insights from A‐HIRATE
Ghali, J. K., Orlov, M. V., Araghi‐Niknam, M., Sherfesee, L., & Hettrick, D. A. (2007) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2007.00772.x · Cited by 13
Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact?
Toma, M. M., BUNGAU, S. G., Ţiţ, D. M., Moisi, M. I., Bustea, C., Vesa, C. M., Behl, T., Stoicescu, M., Brisc, M. C., Purza, A. L., et al. (2022) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2022.113002 · Cited by 12
Atrial Cardiopathy: Redefining Stroke Risk Beyond Atrial Fibrillation
Zhang, J., & Bhat, A. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.06.002 · Cited by 11
Integration of wearable devices and deep learning: New possibilities for health management and disease prevention
Karako, K. (2024) · BioScience Trends · doi:10.5582/bst.2024.01170 · Cited by 13
Concomitant surgical atrial fibrillation ablation and event recorder implantation: better monitoring, better outcome?
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The Guideline-Policy Gap in Direct-Acting Oral Anticoagulants Usage in Atrial Fibrillation: Evidence, Practice, and Public Policy Considerations
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Clinical Presentation of Sustained Monomorphic Ventricular Tachycardia Without Cardiac Arrest
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“13 A possible explanation for the divert symptomatology of patients with VT and SVT could be re-lated to the baseline cardiac dysfunction of patients with VT and their high prevalence of comorbidities consequently making their myocardium more susceptible to ischemia, causing them to experience…”
Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age
Lernfelt, G., Mandalenakis, Z., Hornestam, B., Lernfelt, B., Rosengren, A., Sundh, V., & Hansson, P. (2020) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2020.1729399 · Cited by 11
“the difference appears to decrease with age [11].”
Background
Significance and Management Strategies for Patients with Asymptomatic Atrial Fibrillation.
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Screening of unknown atrial fibrillation through handheld device in the elderly.
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Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry
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Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
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Management of Device-detected Atrial High-rate Episodes
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Successful stenting of stenotic lesion and spontaneous dissection of left internal mammary artery graft
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“On the other hand, AF can be asymptomatic, but this does not decrease the thromboembolic risk of the patient [6].”
Background
Arterial Stiffness Is Associated With Increased Symptom Burden in Patients With Atrial Fibrillation
Kranert, M., Shchetynska‐Marinova, T., Berghoff, T., Liebe, V., Doesch, C., Papavassiliu, T., Custodis, F., Akın, İ., Borggrefe, M. M., & Hohneck, A. L. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.08.022 · Cited by 9
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Update on the Clinical Management of Atrial Fibrillation: Guidelines and Beyond
Curtis, A. B. (2011) · Postgraduate Medicine · doi:10.3810/pgm.2011.11.2491 · Cited by 9
“dent risk factor for stroke, irrespective of age or symptomatology.(6,25,26) Estimates based on data from the Framingham”
Background
How is atrial fibrillation detected in everyday healthcare? Results of a Dutch cohort study
Gurp, N. V.-V., Uittenbogaart, S. B., van de Moosdijk, S. C. M., van Sprang, U. F., Knottnerus, J. A., Stoffers, J., & Lucassen, W. A. M. (2022) · Netherlands Heart Journal · doi:10.1007/s12471-022-01719-2 · Cited by 8
Interactions Between Cardiovascular and Cerebrovascular Disease
Pasquale, G. D., Urbinati, S., Perugini, E., & Gambetti, S. (2012) · Current Treatment Options in Neurology · doi:10.1007/s11940-012-0204-7 · Cited by 8
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Concomitant surgical ablation for atrial fibrillation (AF) in patients with significant atrial dilation >55 mm. Worth the effort?
Pecha, S., Hakmi, S., Subbotina, I., Willems, S., Reichenspurner, H. C., & Wagner, F. (2015) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-015-0337-3 · Cited by 8
“Atrial fibrillation (AF), the most common arrhythmia in patients undergoing cardiac surgery, is associated with an increased risk of death, stroke, and hospitalisation, and is furthermore known to reduce quality of life and exercise capacity [1, 2].”
Background
Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring.
Maria, E. D., & Giacopelli, D. (2015) · PubMed Central · doi:10.4022/jafib.1249 · Cited by 8
Clinical classification and the subclinical atrial fibrillation challenge: a position paper of the European Cardiac Arrhythmia Society
Lévy, S., Santini, L., Cappato, R., Steinbeck, G., Capucci, A., & Saksena, S. V. (2020) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-020-00859-y · Cited by 9
“A substudy from Atrial Fibril lation Follow-up Investigation of Rhythm Management (AFFIRM) study showed that asymptomatic AF patients have less serious heart diseases but more cerebrovascular disease, but the prognosis did not significantly differ in the asymptomatic patient group from the symptomatic group [34].”
Method
Genetics, atrial cardiomyopathy, and stroke: enough components for a sufficient cause?
Camen, S., & Schnabel, R. B. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab523 · Cited by 8
How to Manage Occult Atrial Fibrillation Detected on Long-Term Monitoring
Lip, G. Y. H. (2016) · Circulation · doi:10.1161/circulationaha.115.016797 · Cited by 7
“In an analysis from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial, asymptomatic patients tended to have less serious heart disease and more cerebrovascular disease, but the absence of AF symptoms did not confer a more favorable prognosis.(6) The Asymptomatic Atrial Fibrillation an…”
Method
Palpitations in the Cancer Patient
Essa, H., & Lip, G. Y. H. (2021) · European Cardiology Review · doi:10.15420/ecr.2021.44 · Cited by 7
Screening strategies for atrial fibrillation in the elderly population: a systematic review and network meta-analysis
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Clinical applicability of an artificial intelligence prediction algorithm for early prediction of non-persistent atrial fibrillation
Kim, Y., Joo, G., Jeon, B. K., Kim, D., Shin, T. Y., Im, H., & Park, J. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1168054 · Cited by 7
Surveillance of AF recurrence post-surgical AF ablation using implantable cardiac monitor
Ip, J. E., Maria, V., Grimes, D., Xie, Y., Jager, K., Boak, J., & Gandhi, D. B. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-011-9600-2 · Cited by 7
“In addition, hemodynamic impairment and thromboembolic events related to AF result in significant morbidity, mortality, and healthcare costs [2–5].”
Background
Development of an AI-based non-invasive Pulse AudioGram monitoring device for arrhythmia screening
Lin, C., Chang, Y., Lin, C. K., Tsai, L., & Chen, J. (2017) · IEEE Healthcare Innovations and Point of Care Technologies Conference (HI-POCT) · doi:10.1109/hic.2017.8227579 · Cited by 7
A Clinical Perspective on Atrial Fibrillation
Platonov, P. G., & Corino, V. (2018) · Series in bioengineering · doi:10.1007/978-3-319-68515-1_1 · Cited by 7
Atrial fibrillation in Middle Eastern Arabs and South Asians: Summary of published articles in the Arabian Gulf
Salam, A. M. (2019) · Heart Views · doi:10.4103/heartviews.heartviews_116_19 · Cited by 7
“[27] In addition, about 15% to 30% of patients are asymptomatic.[28-31] It is sometimes practiced that when AF is thought to be suppressed, as evidenced by the absence of clinical symptoms and the presence of sinus rhythm on routine electrocardiograms, some physicians tend to stop anticoagulation in an effort to avoid…”
Background
Standard 12-lead electrocardiogram tele-transmission: Support in diagnosing cardiovascular diseases in operations undertaken by Warsaw-area basic medical rescue teams between 2009 and 2013
Rekosz, J., Kasznicka, M., Kwiatkowska, D., Mączyńska-Mazuruk, R., Kołak, K., Mierzejewska, B., Drogosiewicz, D., Timler, D., & Gałązkowski, R. (2015) · Cardiology Journal · doi:10.5603/cj.a2015.0059 · Cited by 7
“Such cases, the frequency of which can reach nearly 20%, pose a threat to the patient’s life, as it can take more time until aid is administered, which means the increase of the probability that the complications mentioned above will occur [17].”
Background
ANMCO Position Paper: direct oral anticoagulants for stroke prevention in atrial fibrillation: clinical scenarios and future perspectives
Nardi, F., Gulizia, M. M., Colivicchi, F., Abrignani, M. G., Fusco, S. A. D., Lenarda, A. D., Tano, G. D., Geraci, G., Moschini, L., Riccio, C., et al. (2017) · European Heart Journal Supplements · doi:10.1093/eurheartj/sux007 · Cited by 6
Co-prevalence of carotid stenosis and coronary artery disease in Chinese patients with paroxysmal atrial fibrillation
Gu, Y., Feng, L., Xu, Y., & Zhao, Y. (2014) · Journal of International Medical Research · doi:10.1177/0300060514543034 · Cited by 6
Device-identified atrial fibrillation at pacing clinics. Should it guide anticoagulation?
Merinopoulos, I., Raphael, C. E., Yardley, A., Goonewardene, M., & Vassiliou, V. S. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.01.040 · Cited by 7
Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR
Yıldırım, Y., Petersen, J., Aydın, A., Alassar, Y., Reichenspurner, H. C., & Pecha, S. (2022) · Medicina · doi:10.3390/medicina58111607 · Cited by 6
“Furthermore, it leads to heart failure and contributes to an increased number of hospitalizations [1,2].”
Background
Association between the quality of life and asymptomatic episodes of paroxysmal atrial fibrillation in the J-RHYTHM II study
Yamamoto, M., Watanabe, E., Suzuki, T., Yamazaki, T., Ohtsu, H., Ozaki, Y., Ogawa, S., & Yamashita, T. (2013) · Journal of Cardiology · doi:10.1016/j.jjcc.2013.11.011 · Cited by 6

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)
DOI: 10.1016/j.ahj.2004.06.032
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Clinical Neurology › 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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Asymptomatic atrial fibrillation: Demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study

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