Does asymptomatic atrial fibrillation exist?

Abstract

Atrial fibrillation (AF) is currently defined as symptomatic by asking patients if they are aware of when they are in AF and if they feel better in sinus rhythm. However, this approach of defining AF as symptomatic and asymptomatic fails to adequately consider the adverse effects of AF in patients who are unaware of their rhythm including progression from paroxysmal to persistent AF, and the development of dementia, stroke, sinus node dysfunction, valvular regurgitation, ventricular dysfunction, and heart failure. Labeling these patients as asymptomatic falsely suggests that their AF requires less intense therapy and puts into question the notion of truly asymptomatic AF. Because focusing on patient awareness ignores other important consequences of AF, clinical endpoints that are independent of symptoms are being developed. The concept of AF burden has more recently been used as a clinical endpoint in clinical trials as a more clinically relevant endpoint compared to AF‐related symptoms or time to first recurrence, but its correlation with symptoms and other clinical outcomes remains unclear. This review will explore the impact of AF on apparently asymptomatic patients, the use of AF burden as an endpoint for AF management, and potential refinements to the AF burden metric. The review is based on a presentation by the senior author during the 2023 16th annual European Cardiac Arrhythmia Society (ECAS) congress in Paris, France.

High Prevalence of Atrial Fibrillation Found in the Capital of Greenland When Using Continuous Electrocardiogram Monitoring: A Cross-Sectional Study

“…AF increases the risk of developing serious conditions, such as dementia and heart failure, and it is estimated to cause approximately 20% of all ischemic strokes (ISs). 5 The risk is higher among patients with persistent and permanent AF, and as paroxysmal AF can progress to being persistent or permanent, 4 , 6 detection and treatment ofthe condition as early as possible are important. However, paroxysmal AF can be missed on standard electrocardiograms (ECGs), and the recommended approach is that persons suspected of having AF be screened over longer periods of time or with multiple single-point ECGs, to increase the chance of identifying periods with AF.…”