title: A comparison of clinical characteristics and long-term prognosis in asymptomatic and symptomatic patients with first-diagnosed atrial fibrillation: the Belgrade Atrial Fibrillation Study.
abstract: BACKGROUND
  To investigate baseline characteristics and long-term prognosis of carefully characterized asymptomatic and symptomatic patients with atrial fibrillation (AF) in a 'real-world' cohort of first-diagnosed non-valvular AF over a 10-year follow-up period.
  
  
  RESULTS
  We conducted an observational, non-interventional, and single-centre registry-based study of consecutive first-diagnosed AF patients. Of 1100 patients (mean age 52.7±12.2 years and mean follow-up 9.9±6.1 years), 146 (13.3%) had asymptomatic AF. Persistent or permanent AF, slower ventricular rate during AF (<100/min), CHA2DS2-VASc score of 0, history of diabetes mellitus and male gender were independent baseline risk factors for asymptomatic AF presentation (all p<0.01) with a good predictive ability of the multivariable model (c-statistic 0.86, p<0.001). Kaplan-Meier 10-year estimates of survival free of progression of AF (log-rank test=33.4, p<0.001) and ischemic stroke (log-rank test=6.2, p=0.013) were significantly worse for patients with asymptomatic AF compared to those with symptomatic arrhythmia. In the multivariable Cox regression analysis, intermittent asymptomatic AF was significantly associated with progression to permanent AF (Hazard Ratio 1.6; 95% CI, 1.1-2.2; p=0.009).
  
  
  CONCLUSIONS
  In a 'real-world' setting, patients with asymptomatic presentation of their first-diagnosed AF could have different risk profile and long-term outcomes compared to those with symptomatic AF. Whether more intensive monitoring and comprehensive AF management including AF ablation at early stage following the incident episode of AF and increased quality of oral anticoagulation could alter the long-term prognosis of these patients requires further investigation.
authors: Faculty of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia. Electronic address: tanjapotpara@gmail.com.
authors: Tatjana S
authors: TS
authors: Potpara
authors: Marija M
authors: MM
authors: Polovina
authors: Jelena M
authors: JM
authors: Marinkovic
authors: Gregory Y H
authors: GY
authors: Lip
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017115:Catheter Ablation; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000925:Anticoagulants
keywords: Ablation of atrial fibrillation; Asymptomatic atrial fibrillation; Atrial fibrillation; First-diagnosed atrial fibrillation; Progression of atrial fibrillation; Stroke risk factors