Kennedy Harold L
Cardiovascular Disease and Medicine University of South Florida, Tampa, FL.
Ann Noninvasive Electrocardiol. 2015 Nov;20(6):518-25. doi: 10.1111/anec.12307. Epub 2015 Oct 8.
Silent or subclinical asymptomatic atrial fibrillation has currently gained wide interest in the epidemiologic, neurologic and cardiovascular communities. The association of brief episodes of paroxysmal atrial fibrillation or surrogate atrial arrhythmias which predict future clinical adverse events have been established. Nevertheless there exists a confounding array of definitions to indicate its presence without discrete indication of which populations should be examined. Moreover the term "atrial fibrillation burden" (AFB) has emerged from such studies with a plethora of descriptions to prognosticate both arrhythmic and clinical adverse events. This presentation suggests clarification of diagnostic definitions associated with silent atrial fibrillation, and a more precise description of AFB. It examines the populations across the current disease and cardiovascular invasive therapeutic spectrum that lead to both silent atrial fibrillation and AFB. It describes the diagnostic methods of arrhythmia detection utilizing the surface ECG, subcutaneous ECG or intra-cardiac devices and their relationship in seeking meaningful arrhythmic markers of silent atrial fibrillation. Whereas a wide range of clinical risk factors of silent atrial fibrillation have been validated in the literature, there is an ongoing search for those arrhythmic risk factors that precisely identify and prognosticate outcome events in diverse populations at risk of atrial fibrillation and its complications. This presentation identifies this chaos, and focuses attention on the issues to be addressed to facilitate descriptive and comparative scientific studies in the future. It is a call to action specifically to the medical arrhythmic community and its specialty societies (i.e., ISHNE, HRS, EHRA) to begin a quest to unravel the arrhythmic quagmire associated with "silent atrial fibrillation."
隐匿性或亚临床无症状性心房颤动目前在流行病学、神经学和心血管领域引起了广泛关注。阵发性心房颤动的短暂发作或替代性房性心律失常与未来临床不良事件的关联已经得到证实。然而，存在一系列令人困惑的定义来表明其存在，却没有明确指出应检查哪些人群。此外，“房颤负荷”（AFB）这一术语已从这些研究中出现，有大量描述用于预测心律失常和临床不良事件。本报告建议对与隐匿性房颤相关的诊断定义进行澄清，并对AFB进行更精确的描述。它研究了当前疾病和心血管侵入性治疗范围内导致隐匿性房颤和AFB的人群。它描述了利用体表心电图、皮下心电图或心内装置检测心律失常的诊断方法，以及它们在寻找隐匿性房颤有意义的心律失常标志物方面的关系。虽然隐匿性房颤的多种临床危险因素已在文献中得到验证，但仍在不断寻找那些能精确识别和预测房颤及其并发症高危人群结局事件的心律失常危险因素。本报告指出了这种混乱情况，并将注意力集中在未来促进描述性和比较性科学研究需要解决的问题上。这是一项特别呼吁，呼吁心律失常医学领域及其专业学会（即ISHNE、HRS、EHRA）开始努力解开与“隐匿性房颤”相关的心律失常难题。
