SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

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

█ Review

DOI: 10.26430/CHUNGARICA.2022.52.3.234

Vámos Máté1, Kupó Péter2, Miklós Márton1, Benák Attila1, Zsigmond-Előd János1, Gellér László3, Nagy Klaudia Vivien3, Sághy László1, Pap Róbert1
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.


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.


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