Symptomatic atrial fibrillation and risk of cardiovascular events: data from the Euro Heart Survey

Federico Guerra*, Michela Brambatti, Robby Nieuwlaat, Maura Marcucci, Elton Dudink, Harry J. G. M. Crijns, Maria Vittoria Matassini, Alessandro Capucci

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims Atrial fibrillation (AF) is associated with a wide range of clinical presentations. Whether and how AF symptoms can affect prognosis is still unclear. Aims of the present analysis were to investigate potential predictors of symptomatic AF and to determine if symptoms are associated with higher incidence of cardiovascular (CV) events at 1-year follow-up.

Methods and results The Euro Heart Survey on Atrial Fibrillation included 3607 consecutive patients with documented AF and available follow-up regarding symptoms status. Patients found symptomatic at baseline were classified into still symptomatic (SS group; n = 896) and asymptomatic (SA; n = 1556) at 1 year. Similarly, asymptomatic patients at baseline were classified into still asymptomatic (AA group; n = 903) and symptomatic (AS group; n = 252) at 1 year. Demographics, as well as clinical variables and medical treatments, were tested as potential predictors of symptoms persistence/development at 1-year. We also compared CV events between SS and SA groups, and AS and AA groups at 1-year follow-up. Both persistence and development of AF symptoms were associated with an increased risk of CV hospitalization, stroke, heart failure worsening, and thrombo-embolism. AF type, hypothyroidism, chronic heart failure, and chronic obstructive pulmonary disease (COPD), were independently associated with an increased risk of symptomatic status at 1-year follow-up between SS and SA groups.

Conclusion Persistence or development of symptoms after medical treatment are associated with an increased risk of CV events during a 1-year follow-up. Type of AF, along with hypothyroidism, COPD and chronic heart failure are significantly associated with symptoms persistence despite medical treatment.

Original languageEnglish
Pages (from-to)1922-1929
Number of pages8
JournalEP Europace
Issue number12
Publication statusPublished - Dec 2017


  • Atrial fibrillation
  • Symptoms
  • Heart failure
  • Rate control
  • Rhythm control
  • Thrombo-embolism

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