Asymptomatic Atrial Fibrillation: Clinical Correlates, Management, and Outcomes in the EORP-AF Pilot General Registry

Background.Atrial fibrillation is often asymptomatic but outcomes need further characterization.Aims.To investigate clinical presentation, management and outcomes in asymptomatic and symptomatic atrial fibrillation patients prospectively enrolled in the EurObservational Research Programme -Atrial Fibrillation (EORP-AF) Pilot General Registry.Results.A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (EHRA score I).Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) while 919 (48.8%) had severe or disabling symptoms (EHRA III-IV).Permanent atrial fibrillation was threefold more common in asymptomatic than in symptomatic patients.On multivariate analysis, male gender (OR 1.630, 95% CI 1.384-1.921),older age (OR 1.019, 95% CI 1.012-1.026),previous myocardial infarction (OR 1.681, 95% CI 1.350-2.093),and limited physical activity (OR 1.757, 95% CI 1.495-2.064)were significantly associated with asymptomatic (EHRA I) atrial fibrillation.Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%), and was independently associated with male gender, age and previous myocardial infarction.Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, while aspirin was more frequently prescribed.In asymptomatic patients, mortality at 1 year was more than two-fold higher compared to symptomatic patients (9.4 vs. 4.2%, p<0.0001), and was independently associated with older age and comorbidities, including chronic kidney disease and chronic heart failure.Conclusions.Asymptomatic atrial fibrillation is common in daily cardiology practice, being associated with elderly age and more co-morbidities, as well as high thromboembolic risks.A higher 1-year mortality was found in asymptomatic compared to symptomatic patients.