Clinical relevance of silent atrial fibrillation prevalence, prognosis, quality of life, and.pdf

Journal of Interventional Cardiac Electrophysiology 4, 369±382, 2000 #2000 Kluwer Academic Publishers. Manufactured in The Netherlands. Clinical Relevance of Silent Atrial Fibrillation: Prevalence, Prognosis, Quality of Life, and Management Irina Savelieva and A. John Camm St Georges Hospital Medical School, Cranmer Terrace, London, SW17 0RE Abstract. Although ?rst described about 100 yr ago, atrial ?brillation (AF) is now recognized as the most common of all arrhythmias. It has a substantial morbidity and presents a considerable health care burden. Improved diagnosis and an ageing population with an increased likelihood of underlying cardiac disease results in AF in more than 1% of population. AF is associated with an approximately two-fold increase in mortality, largely due to stroke which occurs at an annual rate of 5±7%. Another risk to survival is heart failure, which is aggravated by poor control of the ventricular rate during AF. Usually AF is associated with a variety of symptoms: palpitations, dyspnea, chest discomfort, fatigue, dizziness, and syncope. Paroxysmal AF is likely to be symptomatic and frequently presents with speci?c symptoms, while permanent AF is usually associated with less speci?c symptoms. However, in at least one third of patients, no obvious symptoms or noticeable degradation of quality of life are observed. This asymptomatic, or silent, AF is diagnosed incidentally during routine physical exam- inations, pre-operative assessments or population surveys. Recently, a very large incidence of generally short paroxysms of AF has been seen in patients with implantable pacemakers or de?brillators and these arrhythmias are often silent. Pharmacological suppres- sion of arrhythmia may be associated with a conver- sion from a symptomatic to an asymptomatic form of AF. Holter monitoring and transtelephonic monitoring studies have demonstrated that asymptomatic episodes of AF exceed symptomatic paroxysms by twelve-fold or more. Although symptoms may