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Clinical Articles, News & Views

Time is brain – stroke in patients with asymptomatic AF

Despite support for an association between device-detected atrial tachyarrhythmias(AT)/atrial fibrillation(AF) and stroke, specific recommendations for device-detected subclinical AF are lacking, instead deferring to the CHA2DS2-VASc score to determine who should be anticoagulated, according to a study published recently in the Journal of the American College of Cardiology.1

Since the goal of anticoagulation in AF is primary prevention of stroke, once AF is detected, regardless of the mechanism of detection, anticoagulation should be initiated if indicated on the basis of stroke risk assessment using the CHA2DS2-VASc score, say the authors in their review of the epidemiology of AF and mechanisms of stroke in AF.

Remote device diagnostics from cardiac implantable electronic devices (CIEDs) provide a unique opportunity for early intervention and prevention of stroke, leading to earlier detection and intervention, reduced emergency room visits, increased efficiency for healthcare providers, and improved quality of care for patients, say the authors.

Clinicians with access to remote cardiac device monitoring for patients with CIEDs have an inherent responsibility to act on information gleaned from device diagnostics, they argue, with potential legal ramifications for those who fail to act.

Discrimination against CIED-detected asymptomatic AF is unfounded, represents a lost opportunity by clinicians to have clinically meaningful discussions and shared decision-making with their patients about AF, the associated risk of cerebrovascular accident, and the importance of anticoagulation in stroke prevention, the authors conclude.


1. Chen-Scarabelli C, Scarabelli TM, Ellenbogen KA, Halperin JL. Device-detected atrial fibrillation: what to do with asymptomatic patients? J Am Coll Cardiol 2015;65:281–94.

Published on: January 29, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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