From Detection to Decision: Managing Device-Detected Atrial Fibrillation After Stroke

To summarise contemporary strategies to detect atrial fibrillation (AF) after stroke/transient ischemic attack (TIA) with emphasis on implantable loop recorders (ILRs), evaluate who should receive anticoagulation in device detected AF/atrial high-rate episodes, and evaluate biomarkers that increase the likelihood of detecting AF.

ILRs substantially increase AF detection beyond 12-36 months of monitoring. General population screening with ILRs increases AF diagnosis without a definitive stroke reduction. For subclinical/device detected AF, anticoagulation may reduce stroke but comes at the expense of increased bleeding. The burden of AF, biomarkers and atrial cardiomyopathy markers show promise to stratify risk and guide extended monitoring. An individualized approach is needed to identify who benefits most from ILR and subsequent anticoagulation. Research priorities include outcome-powered trials after stroke/TIA, the role of AF burden in decision making and the role of wearables within clinical pathways.