title: Device-detected atrial fibrillation: what to do with asymptomatic patients?
abstract: Atrial fibrillation (AF) is the most common clinically significant arrhythmia and conveys an increased risk of stroke, regardless of whether it is symptomatic. Despite multiple studies supporting an association between subclinical atrial tachyarrhythmias (ATs) detected by cardiac implantable electronic devices and increased risk of thromboembolic events, clinical intervention for device-detected AT remains sluggish, with some clinicians delaying treatment and instead opting for continued surveillance for additional or longer episodes. However, the 2014 updated clinical practice guidelines on AF recommend use of the CHA2DS2-VASc stroke risk score for nonvalvular AF, with oral anticoagulation recommended for scores ≥2, regardless of whether AF is paroxysmal, persistent, or permanent. This paper reviews the epidemiology of AF and mechanisms of stroke in AF, and discusses device-detected AF and its clinical implications.
authors.affiliation: Veterans Affairs Ann Arbor Health Care System, University of Michigan, Ann Arbor, Michigan.
authors.forename: Carol
authors.initials: C
authors.lastname: Chen-Scarabelli
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York. Electronic address: tiziano.scarabelli@mountsinai.org.
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
authors.affiliation: Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy; D002986:Clinical Trials as Topic; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D004567:Electrodes, Implanted; D006801:Humans; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: atrial tachyarrhythmias; cardiac implantable electronic devices; cerebral embolism; defibrillator; implantable cardiac monitor; stroke