Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients.

Daria Sgreccia,Marco Proietti,Gregory Y H Lip,Marco Vitolo,Marcella Manicardi,Vincenzo Livio Malavasi,Giuseppe Boriani,Anna Chiara Valenti

doi:10.3390/jcm10173979

Abstract

Background: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. Results: From the initial 5476 results retrieved after duplicates’ removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81–1.32), and cardiovascular death (OR 0.87, 95% CI 0.54–1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77–1.93) and stroke/TE (OR 1.06, 95% CI 0.86–1.31) risks. Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.

Highlights

atrial fibrillation (AF) is frequently detected during clinical screening in different settings [2,3,4,5,6,7,8,9]
We performed an extensive search in three major medical literature databases: PubMed, Embase, and Cochrane, for available studies, published in English, that have compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs) events or stroke
The main findings of our systematic review and meta-analysis are as follows: (i) symptomatic and asymptomatic AF patients have comparable likelihood for all-cause death and cardiovascular mortality; (ii) TE events had a similar incidence rate between the two groups; and (iii) in AF patients, clinical outcomes appear to be non-dependent on the presence or absence of symptoms at clinical presentation

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and approximately one-third of AF patients are asymptomatic [1] In such cases, AF is frequently detected during clinical screening in different settings (i.e., pre-operative assessments, cryptogenic stroke, continuous rhythm monitoring through an implanted device) [2,3,4,5,6,7,8,9]. Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status

Methods

Results

Conclusion