Although silent atrial fibrillation (AF) accounts for
a significant proportion of patients with AF, asymptomatic patients have been
excluded from AF ablation trials. This population presents unique challenges to
disease management. Recent evidence suggests that patients with asymptomatic AF
may have a different risk profile and even worse long-term outcomes compared to
patients with symptomatic AF. For the same reasons they might be more prone to
side-effects of antiarrhythmic drugs, including pro-arrhythmias.
The poor correlation between symptoms and AF
demonstrated in several studies should caution physicians against making
clinical decisions depending on symptoms. Although current guidelines recommend
AF ablation only in patients with symptoms, more attention should be paid to
the AF burden and a rhythm control strategy has the potential to improve
morbidity and mortality in AF patients. However, limited data exist regarding
the use of catheter ablation for asymptomatic AF patients.
As ablation techniques have improved, AF ablation has
become more widespread and complication rate decreased. As a result, referrals
of asymptomatic patients for catheter ablation of AF are on the rise. In this
review we discuss the many unresolved questions concerning the role of the
ablative approach in asymptomatic patients with AF.
Credits: Giovanni B Forleo; Luigi Di Biase; Domenico G Della Rocca; Luca Santini; Gaetano Fassini; Andrea Natale; Claudio Tondo