Sgreccia Daria, Manicardi Marcella, Malavasi Vincenzo Livio, Vitolo Marco, Valenti Anna Chiara, Proietti Marco, Lip Gregory Y H, Boriani Giuseppe
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
J Clin Med. 2021 Sep 2;10(17):3979. doi: 10.3390/jcm10173979.
In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation.
We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months.
From the initial 5476 results retrieved after duplicates' removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81-1.32), and cardiovascular death (OR 0.87, 95% CI 0.54-1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77-1.93) and stroke/TE (OR 1.06, 95% CI 0.86-1.31) risks.
Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.
在心房颤动（AF）患者中，症状的存在可指导心率或节律控制治疗方案的抉择，但AF相关结局是否由临床表现的症状状态决定仍不明确。
我们按照PRISMA建议对现有研究进行了系统评价和荟萃分析，这些研究比较了无症状与有症状AF患者在全因死亡率、心血管死亡及血栓栓塞事件（TEs）方面的报告数据。我们纳入了患者总数等于或大于200例、最短随访期为6个月的研究。
在去除重复结果后检索到的最初5476项结果中，共筛选出10项研究。总体而言，纳入了81462例患者，其中21007例（26%）无症状，60455例（74%）有症状。有症状和无症状患者在全因死亡风险（比值比（OR）1.03，95%置信区间（CI）0.81 - 1.32）和心血管死亡风险（OR 0.87，95% CI 0.54 - 1.39）方面未发现差异。有症状和无症状组在卒中风险（OR 1.22，95% CI 0.77 - 1.93）和卒中/TE风险（OR 1.06，95% CI 0.86 - 1.31）方面也无明显差异。
AF患者的死亡率和卒中/TE事件与临床表现的症状状态无关。AF患者管理策略的采用不应基于有症状的临床状态。
