Gone Fishing (for Silent Atrial Fibrillation)
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Atrial fibrillation (AF) is associated with a stubbornly elevated mortality (3.5% –4% per year in trials),1–4 at odds with the decline in mortality after a first myocardial infarction.5 Furthermore, the prevalence and incidence of AF are increasing as our societies get older,6 and treatment of other acute and chronic cardiac disorders that predispose to AF will further prolong the lives of patients at risk of AF. Hence, there is a need to improve outcomes in patients with AF.7
Article see p 930
AF can present in a variety of clinical scenarios. Some patients suffer so much that they seek specialist help to be relieved from the arrhythmia. Others present with diffuse symptoms, often including fatigue and shortness of breath, and are found to be in AF on clinical or ECG examination. In yet others, AF is an incidental finding when an irregular heartbeat is detected on physical examination and/or an ECG is recorded for other reasons, such as during preoperative assessment. In these patients, the diagnosis of AF is made in time to institute therapy, such as oral anticoagulation, rate control, rhythm control, and therapy of concomitant cardiovascular diseases.8 It is estimated that one third of patients with AF are asymptomatic. Paroxysmal AF, in particular, frequently occurs without patient awareness. Studies in which systematic ECG monitoring is used have suggested that 50% to 70% of AF episodes occur without patient symptoms.9 Some patients are particularly unfortunate, and the diagnosis of AF is made only after presentation with an AF-related complication. The most devastating complication of AF is an acute ischemic stroke. In others, paroxysmal, self-terminating AF may remain undiagnosed even after the …