Xiaodong Peng, Qifan Li, Xiaoxia Liu, Liu He, Nian Liu, Cong Yuan, Jiangtao Li, Zixu Zhao, Mingxiao Li, Song Zuo, Xueyuan Guo, Xiaopai Zhao, Ning Zhou, Caihua Sang, Xin Du, Jianzeng Dong, Changsheng Ma
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引用次数: 0
Abstract
Background: Current guidelines recommend rhythm control for atrial fibrillation (AF) based primarily on symptom management, though accumulating evidence indicates potential prognostic benefits beyond symptom relief.
Objective: This study aimed to compare the clinical profile, outcomes, and rhythm control effects between asymptomatic and symptomatic AF patients.
Methods: Of the 15,603 patients enrolled in the China-AF registry, symptom status was classified as asymptomatic or symptomatic according to the European Heart Rhythm Association (EHRA) score. Cox proportional hazards models assessed the associations between symptom status, rhythm control, and composite outcomes (cardiovascular death and stroke). The interaction between symptom status and rhythm control was also examined.
Results: Among the patients, 1,345 (8.6%) were asymptomatic, with a higher proportion of males, non-paroxysmal AF, a prolonged AF course, and eccentric hypertrophy. Rhythm control treatment was applied in 48.9% of asymptomatic and 62.9% of symptomatic patients. Over a median follow-up of five years, the incidence of composite outcomes was similar between asymptomatic and symptomatic patients (1.99% vs. 2.12% person-year; adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.81-1.14). For asymptomatic patients, rhythm control was associated with a reduced risk of composite outcomes (aHR, 0.37; 95% CI, 0.23-0.60), comparable to that in symptomatic patients (aHR, 0.52; 95% CI, 0.49-0.62) (P for interaction = 0.111).
Conclusion: Asymptomatic AF patients had a comparable risk of adverse outcomes as symptomatic patients. Rhythm control was similarly beneficial regardless of symptoms. These findings support expanding rhythm control strategies to asymptomatic patients and may inform future updates to AF management guidelines.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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