Management of device-detected subclinical atrial fibrillation: a European Heart Rhythm Association survey

Device-detected subclinical atrial fibrillation (DDAF) is increasingly documented either with implantable cardiac electronic devices (CIED) or with consumer-based mobile or wearable monitors. We aimed to investigate phisician's reaction to DDAF, which management is still matter of debate.

This is a physician-based survey with 24 multiple-choice questions.

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 h, 26% with AF >6 h, and 15% with AF >5–6 min. 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, ischaemic stroke, or AF burden monitoring) and not routinely, just according to CHA₂DS₂-VA or age.

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.