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.