Symptoms in Atrial Fibrillation

In practice, although the objective goals of therapeutic intervention in atrial fibrillation (AF) are usually framed in terms of the prevention of stroke and of heart failure, the majority of clinical decisions in AF are driven by symptoms.1 The risk of stroke among those with AF is highly heterogeneous and difficult to predict for the individual patient, but there are extensive empirical data supporting current anticoagulation algorithms. A simple awareness of the presence or absence of the arrhythmia is a factor in decisions regarding anticoagulation and cardioversion, but it correlates poorly with arrhythmic episodes.2 The pathophysiological relationship between AF and heart failure is more complex, and data linking intervention for the arrhythmia to a reduction in the incidence of heart failure are much less robust. In the absence of rigorous data on mortality benefit for most interventions in AF, evaluation of the subjective symptom burden in each patient is a central component of the risk-benefit calculation.3Article see p 268 Symptoms in AF are notoriously variable and difficult to compare among individual patients.1–3 The clinical syndromes associated with AF run the gamut from an incidental ECG finding through acute heart failure to syncope. Nevertheless, approximately 25% to 30% of those with the arrhythmia are asymptomatic. Clinicians managing AF also must deal with the wide range in symptom severity observed in those with substantively similar physiology.2 There is also significant variation in the correlation between symptoms and objective findings for any given individual.In the last few years, concerted efforts have been made to characterize symptoms in a number of clinical trials designed to test management strategies in AF.1,3,4 These efforts have largely relied on generic quality-of-life scales such as the SF-36 questionnaire. Such quality-of-life instruments, although time-consuming to administer, offer a multidimensional assessment of …