Rienstra Michiel, Vermond Rob A, Crijns Harry J G M, Tijssen Jan G P, Van Gelder Isabelle C
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen.
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Heart Rhythm. 2014 Jun;11(6):939-45. doi: 10.1016/j.hrthm.2014.03.016. Epub 2014 Mar 13.
Symptoms are a major driver for patients with atrial fibrillation (AF) to seek medical attention and are important to titrate AF therapies. However, a large proportion of patients with AF are asymptomatic.
To investigate the clinical profile and prognosis of patients with asymptomatic recurrent persistent AF in the RAte Control versus Electrical cardioversion for persistent atrial fibrillation study.
Patients with asymptomatic AF (n = 157 [30%]) were compared with patients with symptomatic AF (n = 365 [70%]). The primary end point was a composite of cardiovascular morbidity and mortality.
Patients with asymptomatic AF were younger and more often men than were patients with symptomatic AF. Cardiac diseases were less common. Quality of life (the Medical Outcomes Study Short-form health survey questionnaire) was better in patients with asymptomatic AF and comparable to healthy controls. At baseline and during follow-up, there were no differences in rate control, antiarrhythmic, or anticoagulant drugs; cardioversions; and time in sinus rhythm. After a follow-up of 2.3 ± 0.6 years, the primary end point occurred in 21 (13%) patients with asymptomatic AF and 83 (23%) patients with symptomatic AF. After adjusting for relevant covariates, asymptomatic AF was associated with a lower risk of the primary end point (hazard ratio 0.51; 95% confidence interval 0.29-0.92; P = .024). This difference was driven by significantly less heart failure hospitalizations (0 vs 21 [6%]) and severe effects of antiarrhythmic drugs or digoxin (1 [0.6%] vs 13 [4%]). Importantly, no difference in the occurrence of thromboembolic complications was observed.
Patients with asymptomatic AF were more often men and had less cardiac disease. During follow-up, in patients with asymptomatic AF, heart failure hospitalizations and severe adverse effects of antiarrhythmic and rate control drugs occurred significantly less frequently.
症状是心房颤动（AF）患者寻求医疗关注的主要驱动因素，对于调整AF治疗也很重要。然而，很大一部分AF患者无症状。
在持续性心房颤动的心率控制与电复律研究中，调查无症状复发性持续性AF患者的临床特征和预后。
将无症状AF患者（n = 157 [30%]）与有症状AF患者（n = 365 [70%]）进行比较。主要终点是心血管疾病发病率和死亡率的综合指标。
无症状AF患者比有症状AF患者更年轻，男性比例更高。心脏病不太常见。无症状AF患者的生活质量（医学结果研究简式健康调查问卷）更好，与健康对照组相当。在基线和随访期间，心率控制、抗心律失常或抗凝药物、复律以及窦性心律时间方面没有差异。经过2.3±0.6年的随访，21例（13%）无症状AF患者和83例（23%）有症状AF患者出现了主要终点。在调整相关协变量后，无症状AF与主要终点风险较低相关（风险比0.51；95%置信区间0.29 - 0.92；P = 0.024）。这种差异是由心力衰竭住院显著减少（0例 vs 21例[6%]）以及抗心律失常药物或地高辛的严重不良反应减少（1例[0.6%] vs 13例[4%]）所致。重要的是，未观察到血栓栓塞并发症发生率的差异。
无症状AF患者男性居多，心脏病较少。在随访期间，无症状AF患者心力衰竭住院以及抗心律失常和心率控制药物的严重不良反应发生频率显著较低。
