Karakasis Paschalis, Pamporis Konstantinos, Siontis Konstantinos C, Theofilis Panagiotis, Samaras Athanasios, Patoulias Dimitrios, Stachteas Panagiotis, Karagiannidis Efstratios, Stavropoulos George, Tzikas Apostolos, Kassimis George, Giannakoulas George, Karamitsos Theodoros, Katritsis Demosthenes G, Fragakis Nikolaos
Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eur Heart J. 2025 Apr 1;46(13):1189-1202. doi: 10.1093/eurheartj/ehae694.
Current guidelines suggest that asymptomatic atrial fibrillation (AF) is independently associated with increased risks of stroke and mortality compared with symptomatic AF. Considering that recent investigations have provided conflicting results, the present study aimed to evaluate the association between symptom status and clinical outcomes in patients with AF.
Medline, Cochrane Library, and Scopus were searched until 25 March 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses.
Thirty-six studies (217 850 participants) were included. Based on the frequentist analysis, symptomatic individuals had no significant difference in the risk of all-cause mortality [hazard ratio (HR) .97, 95% confidence interval (CI) .80-1.17], cardiovascular mortality (HR 1.04, 95% CI .72-1.49), thromboembolism (HR 1.06, 95% CI .87-1.28), stroke (HR 1.06, 95% CI .84-1.34), hospitalization (HR 1.34, 95% CI .89-2.02), and myocardial infarction (HR .98, 95% CI .70-1.36), compared to the asymptomatic group. Symptomatic patients had a 33% increased risk of new-onset heart failure (HR 1.33, 95% CI 1.19-1.49) and a 30% lower risk of progression to permanent AF (HR .70, 95% CI .54-.89). The Bayesian analysis yielded comparable results, yet the association between symptom status and new-onset heart failure was not significant (HR 1.27, 95% credible interval .76-1.93; Bayes factor = 1.2). Symptomatic patients had higher odds of receiving antiarrhythmic drugs (odds ratio [OR] 1.64, 95% CI 1.33-2.03) and ablation therapy (OR 1.47, 95% CI 1.06-2.05) compared to asymptomatic cases.
The risk of major clinical outcomes did not differ between individuals with and without AF-related symptoms. Asymptomatic patients had a greater hazard of progression to permanent AF.
当前指南表明，与有症状的心房颤动（AF）相比，无症状性AF与中风和死亡风险增加独立相关。鉴于近期研究结果相互矛盾，本研究旨在评估AF患者症状状态与临床结局之间的关联。
检索截至2024年3月25日的Medline、Cochrane图书馆和Scopus数据库。进行了三轮独立的研究筛选、数据提取和质量评估。采用随机效应荟萃分析汇总证据。
纳入36项研究（217850名参与者）。基于频率分析，有症状个体在全因死亡率[风险比（HR）0.97，95%置信区间（CI）0.80 - 1.17]、心血管死亡率（HR 1.04，95% CI 0.72 - 1.49）、血栓栓塞（HR 1.06，95% CI 0.87 - 1.28）、中风（HR 1.06，95% CI 0.84 - 1.34）、住院（HR 1.34，95% CI 0.89 - 2.02）和心肌梗死（HR 0.98，95% CI 0.70 - 1.36）方面与无症状组相比无显著差异。有症状患者新发心力衰竭风险增加33%（HR 1.33，95% CI 1.19 - 1.49），进展为永久性AF的风险降低30%（HR 0.70，95% CI 0.54 - .89）。贝叶斯分析得出了类似结果，但症状状态与新发心力衰竭之间的关联不显著（HR 1.27，95%可信区间0.76 - 1.93；贝叶斯因子 = 1.2）。与无症状患者相比，有症状患者接受抗心律失常药物治疗（优势比[OR] 1.64，95% CI 1.33 - 2.03）和消融治疗（OR 1.47，95% CI 1.06 - 2.05）的几率更高。
有AF相关症状和无症状个体的主要临床结局风险无差异。无症状患者进展为永久性AF的风险更高。
