Heart rhythm · 2025
Asymptomatic atrial fibrillation: Clinical characteristics, outcomes, and prognostic impact of rhythm control.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Peng Xiaodong, Li Qifan, Liu Xiaoxia, He Liu, Liu Nian, Yuan Cong, Li Jiangtao, Zhao Zixu, Li Mingxiao, Zuo Song, Guo Xueyuan, Zhao Xiaopai, Zhou Ning, Sang Caihua, Du Xin, Dong Jianzeng, Ma Changsheng
Аннотация
BACKGROUND: Current guidelines recommend rhythm control for atrial fibrillation (AF) based primarily on symptom management, although accumulating evidence indicates potential prognostic benefits beyond symptom relief.
OBJECTIVE: This study aimed to compare the clinical profile, outcomes, and rhythm control effects between patients with asymptomatic and symptomatic AF.
METHODS: Of the 15,603 patients enrolled in the China-AF registry, symptom status was classified as asymptomatic or symptomatic according to the European Heart Rhythm Association score. Cox proportional hazards models assessed the associations between symptom status, rhythm control, and composite outcomes (cardiovascular death and stroke). The interaction between symptom status and rhythm control was also examined.
RESULTS: Among the patients, 1345 (8.6%) were asymptomatic, with a higher proportion of males, nonparoxysmal AF, a prolonged AF course, and eccentric hypertrophy. Rhythm control treatment was applied in 48.9% of asymptomatic and 62.9% of symptomatic patients. Over a median follow-up of 5 years, the incidence of composite outcomes was similar between asymptomatic and symptomatic patients (1.99% vs 2.12% person-year; adjusted hazard ratio [aHR] 0.96; 95% confidence interval [CI] 0.81-1.14). For asymptomatic patients, rhythm control was associated with a reduced risk of composite outcomes (aHR 0.37; 95% CI 0.23-0.60), comparable with that in symptomatic patients (aHR 0.55; 95% CI 0.49-0.62) (P for interaction = .111).
CONCLUSION: Patients with asymptomatic AF had a comparable risk of adverse outcomes as symptomatic patients. Rhythm control was similarly beneficial regardless of symptoms. These findings support expanding rhythm control strategies to asymptomatic patients and may inform future updates to AF management guidelines.
OBJECTIVE: This study aimed to compare the clinical profile, outcomes, and rhythm control effects between patients with asymptomatic and symptomatic AF.
METHODS: Of the 15,603 patients enrolled in the China-AF registry, symptom status was classified as asymptomatic or symptomatic according to the European Heart Rhythm Association score. Cox proportional hazards models assessed the associations between symptom status, rhythm control, and composite outcomes (cardiovascular death and stroke). The interaction between symptom status and rhythm control was also examined.
RESULTS: Among the patients, 1345 (8.6%) were asymptomatic, with a higher proportion of males, nonparoxysmal AF, a prolonged AF course, and eccentric hypertrophy. Rhythm control treatment was applied in 48.9% of asymptomatic and 62.9% of symptomatic patients. Over a median follow-up of 5 years, the incidence of composite outcomes was similar between asymptomatic and symptomatic patients (1.99% vs 2.12% person-year; adjusted hazard ratio [aHR] 0.96; 95% confidence interval [CI] 0.81-1.14). For asymptomatic patients, rhythm control was associated with a reduced risk of composite outcomes (aHR 0.37; 95% CI 0.23-0.60), comparable with that in symptomatic patients (aHR 0.55; 95% CI 0.49-0.62) (P for interaction = .111).
CONCLUSION: Patients with asymptomatic AF had a comparable risk of adverse outcomes as symptomatic patients. Rhythm control was similarly beneficial regardless of symptoms. These findings support expanding rhythm control strategies to asymptomatic patients and may inform future updates to AF management guidelines.