Asymptomatic atrial fibrillation and risk of stroke

The incidence of atrial fibrillation rises with advancing age. About 10% of patients over 80 years suffer from atrial fibrillation, but episodes are often not recognized. However, about 25% of cryptogenic strokes are caused by asymptomatic atrial fibrillation showing a significant risk of thromboembolism by this condition. New insertable cardiac monitors or wearable sensors offer the opportunity of continuous rhythm monitoring over wider time spans. Thereby, they enable detection of asymptomatic atrial fibrillation episodes. Several lines of evidence point towards an association between duration of asymptomatic episodes and thromboembolic risk. However, definite data on optimal risk stratification and therapy is missing in this collective. Currently, oral anticoagulation should be initiated according to the CHA2DS2VASc Score. Given the better safety profile of direct oral anticoagulants these substances should be preferred. In patients with high bleeding risk and asymptomatic atrial fibrillation, catheter-based left appendage occlusion may represent a valuable alternative to oral anticoagulation.