Device-Detected Subclinical Atrial Fibrillation and Increased Stroke Risk

Abstract

Atrial fibrillation (AF) is one of the major causes of stroke. Data from the literature show that among the causes of stroke 60% is attributable to cerebrovascular diseases, 15% to AF, while about 25% of cases do not identify recognizable causes. The technological advancement of cardiac implanted electronic devices has enabled the identification of subclinical atrial fibrillation (SCAF). The literature shows that SCAF is very frequent in the elderly population and that it represents a risk factors for the onset of stroke or systemic embolic disease, regardless of other cardiovascular risk factors. While for clinical atrial fibrillation (AF) the advantages of anticoagulant therapy based on the CHA2DS2-VASCscore have been well established, much less is known about the usefulness of anticoagulant therapy in the case of SCAF. The role of the CHA2DS2-VASCscore is much debated, although recently a study has clearly shown that the number and duration of SCAF episodes together with the CHA2DS2-VASC score plays an important role in determining the risk of progression to a persistent AF. Based on these data, the ongoing ARTESIA and AFNET-NOAH studies will provide us with data to evaluate the net clinical benefit of anticoagulation in SCAF.