Management of device-detected subclinical atrial fibrillation: A european heart rhythm association survey

Abstract Background and aims Device-detected subclinical atrial fibrillation (DDAF) is increasingly documented either with implantable cardiac electronic devices (CIED) or with consumer-based mobile or wearable monitors. The management of this condition is still matter of debate. Methods This is a physician-based survey with 24 multiple-choice questions. Results A total of 222 physicians from 46 countries responded the survey. DDAF is frequent, occurring in >10% of CIEDs follow-up for 37% of respondents. Oral anticoagulation is prescribed according to CHA2DS2-VA and AF duration; 34% of the respondents initiate anticoagulation with AF > 24 hours, 26% with AF > 6 hours and 15% with AF > 5-6 minutes. Respondents from Non-European countries and Mediterranean Europe are more likely to prescribe diagnostic exams and therapy than respondents from North Europe. Systematic long-term AF screening with implantable loop recorder (ILR) after cryptogenic stroke ranges from 43±27% of ILR implanted for that purpose in Mediterranean countries to 10±20% in North Europe. The majority of responders recommends the use of consumer-based devices to screen for AF mainly in specific situations (undiagnosed palpitations, ischemic stroke or AF burden monitoring) and not routinely, just according to CHA2DS2-VA or age. Conclusion AF screening is not routinely performed, either in primary or secondary prevention of stroke. Device-detected AF is not uncommon and generally managed based on thromboembolic risk and duration of episodes; the cut-offs of AF duration, global burden and number of episodes are yet to be determined in terms of role and clinical value. Clinicians’ approaches to subclinical AF remain heterogeneous.