Subclinical atrial fibrillation and risk of stroke: An update

Stroke is one of the major causes of death and disability. Atrial fibrillation causes 15% of strokes, 60% is caused by cerebrovascular disease, whereas 25% of cases have no known cause. The technological advancement of cardiac implanted electronic devices has enabled the identification of subclinical atrial fibrillation (SCAF). The literature shows that SCAF is very frequent in the elderly population and that it represents a risk factors for the onset of stroke or systemic embolic disease, regardless of other cardiovascular risk factors. While for clinical atrial fibrillation (AF) the advantages of anticoagulant therapy based on the CHA2 DS2 -VASC score have been well established, much has been said about the usefulness of anticoagulant therapy in the case of SCAF. The role of AF and CHA2 DS2 -VASC score is much debated. A study has recently clearly shown how the SCAF burden together with CHA2 DS2 -VASC score play an important role in determining the risk of progression to persistent AF. Based on these data, the ongoing ARTESIA and AFNET-NOAH studies will provide us with data to evaluate the efficacy of anticoagulant therapy in SCAF.