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Heart Rhythm. 2016 Jul;13(7):1418-24. doi: 10.1016/j.hrthm.2016.03.003. Epub 2016 Mar 4.

Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications.

Author information

1
Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
2
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
3
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
4
Department of Nursing Administration, Mayo Clinic, Rochester, Minnesota.
5
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
6
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Electronic address: chamberlain.alanna@mayo.edu.

Abstract

BACKGROUND:

The prognostic significance of the clinical presentation of atrial fibrillation (AF) is poorly defined.

OBJECTIVE:

The purpose of this study was to determine the frequency, associations, and prognostic impact of different clinical presentations of new-onset AF.

METHODS:

One thousand patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-2010). Patients with AF that was complicated at presentation (heart failure [n = 71], thromboembolism [n = 24]), provoked (n = 346), or unable to determine symptoms (n = 83) were excluded. In the remaining patients, characteristics and prognosis associated with different types of symptoms were examined.

RESULTS:

Among 476 patients, 193 had typical (palpitations), 122 had atypical (other non-palpitation symptoms), and 161 had asymptomatic AF presentation. Patients with typical presentation had lower CHA2DS2-VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P <.001). Fifty-nine cerebrovascular events and 149 deaths (n = 49 cardiovascular) were documented over median 5.6 and 6.0 years, respectively. Atypical and asymptomatic AF conferred higher risks of cerebrovascular events compared to typical AF after adjustment for CHA2DS2-VASc score and age (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.65-7.48, and HR 2.70, 95% CI 1.29-5.66, respectively), and associations remained statistically significant after further adjustments including comorbidities and warfarin use. Asymptomatic AF was associated with an increased risk of cardiovascular (HR 3.12, 95% CI 1.50-6.45) and all-cause mortality (HR 2.96, 95% CI 1.89-4.64) compared to typical AF after adjustment for CHA2DS2-VASc score and age.

CONCLUSION:

The type of clinical presentation may have important implications for the prognosis of new-onset AF in the community.

KEYWORDS:

Atral fibrillation; Clinical presentation; Palpitations; Prognosis; Stroke

PMID:
26961300
PMCID:
PMC4802367
DOI:
10.1016/j.hrthm.2016.03.003
[Indexed for MEDLINE]
Free PMC Article

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