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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Contemporary Practices for Management of Subclinical Atrial Fibrillation

Buthainah Alhwarat1, Omar Darwish1, Sai Nikhila Ghanta2

  • 1Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

Journal of Clinical Medicine
|August 14, 2025
PubMed

Insights

Subclinical atrial fibrillation (SCAF) detected by cardiac devices requires individualized oral anticoagulation decisions. Balancing stroke risk and bleeding potential is key for managing these asymptomatic arrhythmias.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Subclinical atrial fibrillation (SCAF) is common in patients with cardiac implantable electronic devices (CIEDs).
  • SCAF episodes may precede clinical atrial fibrillation and increase thromboembolic event risk.
  • Management strategies for SCAF, particularly oral anticoagulation (OAC) use, are not well-established and remain controversial.

Purpose of the Study:

  • To review current literature and clinical studies on SCAF management.
  • To guide decision-making regarding anticoagulation therapy for SCAF.
  • To identify treatment options to limit complications in patients with SCAF.

Main Methods:

  • Comprehensive literature review using Medline, Scopus, Google Scholar, and Embase databases.
  • Analysis of current literature and clinical studies pertaining to SCAF and atrial high-rate episodes (AHREs).
  • Focus on evidence guiding anticoagulation and complication-limiting strategies.

Main Results:

  • The decision to initiate OAC for SCAF/AHREs should be individualized.
  • Risk-benefit assessment balancing stroke risk against bleeding potential is crucial.
  • Optimal patient subgroups benefiting from OAC require further clarification.

Conclusions:

  • Individualized assessment is paramount for OAC decisions in SCAF/AHREs.
  • Ongoing research is necessary to refine treatment guidelines for SCAF.
  • Future studies will clarify which patient subgroups benefit most from anticoagulation therapy.

Keywords:
atrial high-rate episodesdevice-detected atrial fibrillationstroke preventionsubclinical atrial fibrillation

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