title: Asymptomatic versus symptomatic persistent atrial fibrillation: clinical and noninvasive characteristics.
abstract: OBJECTIVE
  This prospective study was designed to investigate the differences between asymptomatic versus symptomatic arrhythmia as well as left ventricular dysfunction in a consecutive population of patients with persistent atrial fibrillation.
  
  
  METHODS
  A total of 282 consecutive outpatients referred with persistent atrial fibrillation formed the study population. A structured medical history was obtained. A two-dimensional transthoracic echocardiography to assess the left ventricular function and a 24-h electrocardiogram (ECG) recording were performed. Irregularity of the heart rhythm was analysed with heart rate variability (HRV) in the time domain as well as maximum and minimum heart rate and the longest pause.
  
  
  METHODS
  Three university hospitals.
  
  
  RESULTS
  The mean age of the patients was 69 years and the mean duration of atrial fibrillation was 7 months. The prevalence of symptomatic patients was 68%, while 32% had no symptoms from atrial fibrillation, left ventricular dysfunction was observed in 20%. Asymptomatic subjects had more often lone atrial fibrillation than those with symptoms. Valvular heart disease was an independent predictor of symptoms while male gender, ischaemic heart disease and a high heart rate were independent predictors of impaired left ventricular function.
  
  
  CONCLUSIONS
  Valvular heart disease is related to symptoms in persistent atrial fibrillation. Ischaemic heart disease, male gender and a high heart rate are more common in patients with impaired left ventricular function. Compromised left ventricular function does, occur also in asymptomatic subjects underlining the importance of a careful investigation including echocardiography in all subjects with persistent atrial fibrillation.
authors.affiliation: Department of Cardiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden. viveka.frykman@ks.se
authors.forename: V
authors.initials: V
authors.lastname: Frykman
authors.forename: M
authors.initials: M
authors.lastname: Frick
authors.forename: M
authors.initials: M
authors.lastname: Jensen-Urstad
authors.forename: J
authors.initials: J
authors.lastname: Ostergren
authors.forename: M
authors.initials: M
authors.lastname: Rosenqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*