Asymptomatic versus symptomatic persistent atrial fibrillation: clinical and noninvasive characteristics

Objective. This prospective study was designed to investigate the differenc es between asymptomatic versus symptomatic arrhythmia as well as left ventr icular dysfunction in a consecutive population of patients with persistent atrial fibrillation. Design. A total of 282 consecutive outpatients referred with persistent atr ial fibrillation formed the study population. A structured medical history was obtained. A two-dimensional transthoracic echocardiography to assess th e left ventricular function and a 24-h electrocardiogram (ECG) recording we re 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. Setting. 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 w as 68%, while 32% had no symptoms from atrial fibrillation, left ventricula r dysfunction was observed in 20%. Asymptomatic subjects had more often lon e atrial fibrillation than those with symptoms. Valvular heart disease was an independent predictor of symptoms while male gender, ischaemic heart dis ease and a high heart rate were independent predictors of impaired left ven tricular function. Conclusion. Valvular heart disease is related to symptoms in persistent atr ial fibrillation. Ischaemic heart disease, male gender and a high heart rat e are more common in patients with impaired left ventricular function. Comp romised left ventricular function does, occur also in asymptomatic subjects underlining the importance of a careful investigation including echocardio graphy in all subjects with persistent atrial fibrillation.