Clinical Impact of Asymptomatic Presentation Status in Patients with Paroxysmal and Sustained Atrial Fibrillation: The Fushimi AF Registry

BACKGROUND: The clinical characteristics and outcomes of asymptomatic patients with paroxysmal or persistent/permanent atrial fibrillation (AF) are largely unknown.

METHODS: The Fushimi AF Registry is a community-based prospective survey of AF patients who visited the participating medical institutions in Fushimi-ku, Japan. We investigated the clinical characteristics and outcomes of asymptomatic versus symptomatic patients in the paroxysmal (n=1,837) and persistent/permanent (as sustained: n=1,912) AF subgroups.

RESULTS: In the paroxysmal AF (PAF) group, asymptomatic patients were older (asymptomatic vs. symptomatic: 74.1 vs. 71.1 years of age; p<0.01), more often male (62.1% vs. 55.6%; p<0.01), and had a higher CHA2DS2-VASc score (mean 3.37±1.73 vs. 2.99±1.63; p<0.01), while the prevalence of major comorbidities and CHA2DS2-VASc scores were comparable in the sustained AF (SAF) group. Multivariable analysis indicated that age (≥75 years), history of stroke/SE, male sex, and chronic kidney disease were independent determinants of asymptomatic status in the PAF group, while age was non-significant in the SAF group. During the follow-up period, all-cause mortality was significantly higher (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.31-2.29; p<0.01) in asymptomatic patients compared with symptomatic patients in the PAF group, while it was comparable in the SAF group.

CONCLUSIONS: Asymptomatic clinical status is associated with older age, males, more co-morbidities with higher stroke risk profile, and a higher incidence of all-cause death in patients with PAF, whereas these characteristics and outcomes were not seen in the SAF group.