Atrial fibrillation (AF) is a common arrhythmia associated with substantial morbidity, mortality, and health care cost. Although AF is responsible for a variety of symptoms, at least one third of patients report no overt symptoms and are unaware of their arrhythmic condition.1 This silent AF is diagnosed incidentally during routine physical or electrocardiographic examination. In some cases, asymptomatic AF is revealed only after complications such as stroke or congestive heart failure have occurred. Implantable pacemakers or defibrillators equipped with long term Holter memory function have shown that a very large proportion of patients (> 50%) have unsuspected episodes of silent AF.2

Silent AF is likely to be associated with morbidity and mortality rates similar to those in symptomatic AF, but its effect on quality of life (QoL) has not yet been established. We studied 154 patients with paroxysmal (60.5%) or persistent (39.5%) AF. Symptoms relevant for AF were selected from Bubien and Kay's symptom checklist, including palpitations, dyspnoea, dizziness, exercise intolerance, chest discomfort, and syncope. Thirty eight patients with the lowest quartile symptom scores (⩽ 25.4) were considered asymptomatic or very mildly symptomatic (group 1); 118 patients in the other three quartiles (> 25.4) were considered symptomatic (group 2). Palpitations (68%), dyspnoea (60%), and …