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Open Access 28-08-2024 | Atrial Fibrillation | Review

Management of Device Detected Subclinical Atrial Fibrillation

Authors: Thomas Salmon, Peter Calvert, Gregory Y. H. Lip

Published in: Current Cardiovascular Risk Reports

Abstract

Purpose of Review

Whilst the management of clinically apparent atrial fibrillation (AF) is well-described and evidenced, the same is not true for subclinical atrial fibrillation (SCAF) and atrial high rate episodes (AHRE). In this review article we discuss the management of device-detected AHRE/SCAF in light of recent major trials and meta-analyses.

Recent Findings

Anticoagulation in AHRE/SCAF reduces thromboembolic risk but causes an increase in bleeding events. Of note, ischaemic stroke risk in untreated AHRE/SCAF has been observed to be lesser than that of untreated clinically evident AF. With regard to reduction of AHRE/SCAF prevalence or burden, increased physical activity has been associated with reduced AHRE/SCAF incidence in a dose-dependent manner. There exists mixed evidence for both angiotensin 2 inhibition therapy and statin therapy in the prevention of AHRE/SCAF in studies with smaller populations. Ongoing studies are assessing the impact of sodium-glucose cotransporter-2 inhibition on AHRE/SCAF. Although there is no evidence for atrial overdrive pacing in preventing AHRE/SCAF, limited evidence suggests pacing lead position and reducing ventricular pacing may minimise AHRE/SCAF.

Summary

The identification of AHRE/SCAF poses unanswered questions regarding treatment. The benefit of anticoagulation in reducing ischaemic stroke is lesser than that seen in clinical AF. As such, anticoagulation decisions in AHRE/SCAF should take into consideration individual bleeding risk, thromboembolic risk, and arrythmia burden. Management of co-morbidities and physical activity show promise in reducing AHRE/SCAF. Further study is required to investigate the impact of various pharmacologic interventions and pacing considerations on the reduction of AHRE/SCAF.

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Title: Management of Device Detected Subclinical Atrial Fibrillation
Authors: Thomas Salmon
Peter Calvert
Gregory Y. H. Lip
Publication date: 28-08-2024
Publisher: Springer US
Keywords: Atrial Fibrillation
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
Digital Health
General Medicine
Published in: Current Cardiovascular Risk Reports
Print ISSN: 1932-9520
Electronic ISSN: 1932-9563
DOI: https://doi.org/10.1007/s12170-024-00748-3

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Management of Device Detected Subclinical Atrial Fibrillation

Abstract

Purpose of Review

Recent Findings

Summary

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Keynote webinar | Spotlight on medication adherence

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Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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2024 ESC Congress

Noise pollution dangerous for heart health

Post-TAVI follow up: deploying virtual assistants

Antihypertensives: more effective at morning or night?

Low Lp(a) levels unlikely to increase the risk of diabetes

» View more highlights on the 2024 ESC Congress hub page

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