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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Major clinical outcomes in symptomatic vs. asymptomatic atrial fibrillation: a meta-analysis

Paschalis Karakasis1, Konstantinos Pamporis2, Konstantinos C Siontis3

  • 1Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.

European Heart Journal
|October 21, 2024
PubMed

Insights

Symptom status in atrial fibrillation (AF) patients did not significantly impact major clinical outcomes like stroke or mortality. However, asymptomatic individuals showed a higher risk of progressing to permanent AF.

Area of Science:

  • Cardiology
  • Clinical Outcomes Research
  • Atrial Fibrillation Management

Background:

  • Current guidelines link asymptomatic atrial fibrillation (AF) to higher risks of stroke and mortality than symptomatic AF.
  • Conflicting recent evidence necessitates a re-evaluation of symptom status and clinical outcomes in AF patients.

Purpose of the Study:

  • To evaluate the association between symptom status and clinical outcomes in patients diagnosed with atrial fibrillation.
  • To clarify the prognostic implications of symptomatic versus asymptomatic atrial fibrillation.

Main Methods:

  • A systematic literature search was conducted across Medline, Cochrane Library, and Scopus databases.
  • Triple-independent study selection, data extraction, and quality assessment were performed.
  • Random-effects meta-analyses were employed to pool evidence from 36 studies involving 217,850 participants.

Main Results:

  • No significant differences in risks of all-cause mortality, cardiovascular mortality, thromboembolism, stroke, hospitalization, or myocardial infarction were found between symptomatic and asymptomatic AF patients.
  • Symptomatic patients had a 33% increased risk of new-onset heart failure and a 30% lower risk of progression to permanent AF.
  • Symptomatic patients were more likely to receive antiarrhythmic drugs and ablation therapy.

Conclusions:

  • Major clinical outcomes did not significantly differ based on AF symptom status.
  • Asymptomatic atrial fibrillation patients demonstrated a greater hazard of progression to permanent AF.
Abstract

Keywords:
AsymptomaticAtrial fibrillationEHRA scoreSymptomaticSymptoms

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