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

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 CHA2 DS2 -VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P