Association of atrial fibrillation symptom with clinical outcomes: a prospective multicenter registry study

Abstract

Abstract Background and Objectives Atrial fibrillation (AF) is usually classified on the basis of the disease subtype. However, this characterization does not capture the full heterogeneity of AF. This study was performed to evaluate whether the remodeling of heart, treatment of AF, and clinical outcome is different according to the symptom of AF. Patients and Methods In the prospective, multicenter study of AF registry, we identified 10,210 patients with non-valvular AF (mean age, 66.7 years; 35.3% were women) enrolled between June 2016 and March 2022 with eligible follow-up visits. The patients were classified into two groups according to the presence of AF symptoms. Clinical factors related with AF symptoms were analyzed. The primary outcome was defined as a composite of all cause death, ischemic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and hospitalization for heart failure. Results Among 10,210 patients, 4,327 (42%) were symptomatic AF, and 5,883 (58%) were asymptomatic AF. The asymptomatic group had older age, more male sex, comorbidities such as hypertension and diabetes mellitus, larger LA AP diameter (43.6 vs. 42.2, P <0.001), and higher E/E’(10.4 vs. 10.0, P <0.001). During median follow-up of 32.9 (29.5 ∼ 36.4) months, incidence of the primary outcome in Asymptomatic vs. Symptomatic were 1.44 and 1.45 per 100 person-year, respectively. In multivariable Cox regression analysis, AF symptoms were not associated with an increased risk of the primary outcome (HR 1.02; 95% CI, 0.81 ∼ 1.29, P = 0.871). In linear regression, symptom of AF was negatively associated with LA AP diameter (β coefficient -0.43, 95% CI -0.76 ∼ -0.11, P = 0.009). Conclusions In the multicenter prospective AF registry, the presence of AF symptoms was not related to cardiovascular outcomes. However, AF symptoms were related to LA remodeling.Cumulative incidence for primary outcomeLinear regression for LA AP diameter