Reiffel James A
Department of Medicine, Division of Cardiology, Electrophysiology Section, Columbia University, New York, NY, USA.
J Innov Card Rhythm Manag. 2017 Nov 15;8(11):2886-2893. doi: 10.19102/icrm.2017.081102. eCollection 2017 Nov.
Silent atrial fibrillation (AF) is common. In some patients, it is the only manifestation of AF, while in others, the AF may be symptomatic or both symptomatic and asymptomatic. Regardless, however, to date, the significance, detection, and management considerations for silent AF have been incompletely elucidated. This current study aimed to review, for both the current clinician and investigator, considerations and attitudes and the ongoing studies, respectively, with respect to silent AF. The methods used were a literature review and personal trial and clinical experience; the frequency of silent AF, concerns regarding silent AF, methods to detect silent AF, and prospective trials focused on the detection and management of silent AF were considered. The results of the literature search indicated that recently conducted relevant trials, such as PREDATE AF, ASSERT-II, and REVEAL AF, have shown that silent AF is frequent in patients with risk markers for AF and stroke in whom no prior AF history is present, and in whom no pacemaker or implantable cardioverter-defibrillator implantations have been previously performed. Furthermore, the GLORIA-AF Registry has reported the observance of more permanent AF and more prior strokes in asymptomatic patients. Ongoing trials such as ARTESiA and NOAH-AFNET 6 are expected to clarify the benefits and risks of oral anticoagulation in patients with silent AF. At present, when silent AF is detected in patients with stroke risk markers, most practitioners initiate an anticoagulation regimen.
隐匿性心房颤动（房颤）很常见。在一些患者中，它是房颤的唯一表现，而在另一些患者中，房颤可能有症状，或者既有症状又有无症状表现。然而，无论如何，迄今为止，隐匿性房颤的意义、检测及管理方面的考量尚未完全阐明。本项研究旨在分别为临床医生和研究人员回顾关于隐匿性房颤的考量因素、态度及正在进行的研究。所采用的方法为文献综述、个人试验及临床经验；研究内容包括隐匿性房颤的发生率、对隐匿性房颤的关注、检测隐匿性房颤的方法以及专注于隐匿性房颤检测与管理的前瞻性试验。文献检索结果表明，近期开展的相关试验，如PREDATE AF、ASSERT-II和REVEAL AF，已显示隐匿性房颤在无房颤病史、未植入起搏器或植入式心脏复律除颤器且有房颤和卒中风险标志物的患者中很常见。此外，GLORIA-AF注册研究报告称，无症状患者中持续性房颤和既往卒中更为常见。预计正在进行的试验，如ARTESiA和NOAH-AFNET 6，将阐明隐匿性房颤患者口服抗凝治疗的获益与风险。目前，当在有卒中风险标志物的患者中检测到隐匿性房颤时，大多数从业者会启动抗凝治疗方案。
