Management of device-detected subclinical atrial fibrillation: a European Heart Rhythm Association survey
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Authors
Meynet I.
Karvonen J.
Boriani G.
Penela D.
Mazurek M.
Mugnai G.
Providencia R.
Futyma P.
Metzner A.
Chun J.K.R.
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Issue Date
2025
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Article
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Abstract
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. We aimed to investigate phisician's reaction to DDAF, which management 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 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. 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. Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Europace
Volume
27
Issue
12