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Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future

1
Division of Cardiology, McGill University Health Center, Montreal, QC H3G1A4, Canada
2
Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, QC H3A2B4, Canada
3
Depatment of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy
4
Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, 35121 Padua, Italy
5
Hôspital Sacré-Coeur de Montréal, Montreal, QC H4J1C5, Canada
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(10), 611; https://doi.org/10.3390/medicina55100611
Received: 30 June 2019 / Revised: 24 August 2019 / Accepted: 17 September 2019 / Published: 20 September 2019
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
Subclinical atrial fibrillation (SCAF) describes asymptomatic episodes of atrial fibrillation (AF) that are detected by cardiac implantable electronic devices (CIED). The increased utilization of CIEDs renders our understanding of SCAF important to clinical practice. Furthermore, 20% of AF present initially as a stroke event and prolonged cardiac monitoring of stroke patients is likely to uncover a significant prevalence of SCAF. New evidence has shown that implanting cardiac monitors into patients with no history of atrial fibrillation but with risk factors for stroke will yield an incidence of SCAF approaching 30–40% at around three years. Atrial high rate episodes lasting longer than five minutes are likely to represent SCAF. SCAF has been associated with an increased risk of stroke that is particularly significant when episodes of SCAF are greater than 23 h in duration. Longer episodes of SCAF are incrementally more likely to progress to episodes of SCAF >23 h as time progresses. While only around 30–40% of SCAF events are temporally related to stroke events, the presence of SCAF likely represents an important risk marker for stroke. Ongoing trials of anticoagulation in patients with SCAF durations less than 24 h will inform clinical practice and are highly anticipated. Further studies are needed to clarify the association between SCAF and clinical outcomes as well as the factors that modify this association. View Full-Text
Keywords: subclinical atrial fibrillation; atrial high rate episodes; stroke subclinical atrial fibrillation; atrial high rate episodes; stroke
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AlTurki, A.; Marafi, M.; Russo, V.; Proietti, R.; Essebag, V. Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future. Medicina 2019, 55, 611.

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