Subclinical and Asymptomatic Atrial Fibrillation: Current Evidence and Unsolved Questions in Clinical Practice.

Andrea Ballatore,Fiorenzo Gaita,Gaetano Maria De Ferrari,Andrea Saglietto,Pier Paolo Bocchino,Mario Matta,Paolo Desalvo,Matteo Anselmino

doi:10.3390/medicina55080497

Andrea Ballatore, Fiorenzo Gaita + Show 6 more

Open Access

https://doi.org/10.3390/medicina55080497

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Abstract

Atrial Fibrillation (AF) may be diagnosed due to symptoms, or it may be found as an incidental electrocardiogram (ECG) finding, or by implanted devices recordings in asymptomatic patients. While anticoagulation, according to individual risk profile, has proven definitely beneficial in terms of prognosis, rhythm control strategies only demonstrated consistent benefits in terms of quality of life. In fact, evidence collected by observational data showed significant benefits in terms of mortality, stroke incidence, and prevention of cognitive impairment for patients referred to AF catheter ablation compared to those medically treated, however randomized trials failed to confirm such results. The aims of this review are to summarize current evidence regarding the treatment specifically of subclinical and asymptomatic AF, to discuss potential benefits of rhythm control therapy, and to highlight unclear areas.

Highlights

Atrial fibrillation (AF), the most common sustained arrhythmia [1], is associated with an increased risk of thromboembolic events such as transient ischemic attack (TIA), ischemic stroke with overt neurological sequelae [2], or micro-embolic events resulting in subclinical brain lesions
AF is independently associated with a higher risk of developing dementia [3], with up to a 30% increased risk regardless of clinical cerebrovascular events [4]
In the incident AF population the risk of developing dementia was increased after censoring for stroke (HR, 1.27; 95% CI 1.18–1.37)

Summary

Introduction

Atrial fibrillation (AF), the most common sustained arrhythmia [1], is associated with an increased risk of thromboembolic events such as transient ischemic attack (TIA), ischemic stroke with overt neurological sequelae [2], or micro-embolic events resulting in subclinical brain lesions (revealed by neuroimaging techniques). Early diagnosis can be difficult in the case of an asymptomatic presentation, defined as sustained AF episodes in patients not presenting palpitations, dyspnea, fatigue, or other AF related symptoms [5]. Subclinical AF can be diagnosed in patients with fewer risk factors [10] as paroxysmal AF, for example, at the early phase of arrhythmia development and progression. Variability in terminology among studies, as later discussed, increases uncertainty related to the description of asymptomatic AF

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