Subclinical atrial fibrillation and anticoagulant therapy: What do we know in 2022?

█ Review

DOI: 10.26430/CHUNGARICA.2022.52.3.234

Authors:
Vámos Máté¹, Kupó Péter², Miklós Márton¹, Benák Attila¹, Zsigmond-Előd János¹, Gellér László³, Nagy Klaudia Vivien³, Sághy László¹, Pap Róbert^1
1Szegedi Tudományegyetem, Belgyógyászati Klinika, Szeged
²Pécsi Tudományegyetem, Szívgyógyászati Klinika, Pécs
³Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Levelezési cím:
Dr. Vámos Máté PhD, med. habil.
Szegedi Tudományegyetem, Belgyógyászati Klinika, Elektrofiziológia Részleg, 6725 Szeged, Semmelweis u. 8.
E-mail: vamos.mate@gmail.com; vamos.mate@med.u-szeged.hu

Summary

This review focuses on the risk-benefit ratio of anticoagulant therapy in subclinical atrial fibrillation (SCAF) detected by implantable cardiac electronic devices. To the best of our knowledge, we have to count on the increase of stroke risk after the detection of SCAF episodes lasting ≥5-6 minutes. Although the absolute risk is lower compared to that one observed in clinical atrial fibrillation (AF), the risk increases gradually with SCAF burden. The temporal relationship bet­ween atrial arrhythmias and stroke events is not always consistent, suggesting that SCAF/AF is also a risk marker and not always the direct cause of stroke. Several studies have been conducted in SCAF and/or stroke of unknown origin to investigate the role of intensive monitoring and anticoagulant treatment strategies, reporting contradictory results at more endpoints. Based on the available evidence and current recommendations, the decision to introduce anticoagulation in these patients should be based on an individual and dynamic evaluation of the thromboembolic risk and the length/frequency of SCAF events.

ISSUE: CARDIOLOGIA HUNGARICA | 2022 | VOLUME 52, ISSUE 3

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