Key result
Anticoagulation for subclinical AF warrants an individualized approach weighing burden, cardiomyopathy, and clinical stroke risk.
This review proposes an evidence-based clinical framework for individualizing long-term anticoagulation in patients with device-detected subclinical atrial fibrillation by integrating arrhythmia burden, clinical risk, and atrial cardiomyopathy.
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Supports individualized anticoagulation decisions in device-detected subclinical AF; leaves open the need for prospective validation of this framework.
The increasing use of wearable monitoring technologies and cardiac implantable electronic devices (CIEDs) has led to frequent incidental detection of subclinical atrial fibrillation (SCAF), yet the role of long-term anticoagulation remains uncertain. Growing evidence indicates that SCAF is a separate clinical entity on the continuous spectrum of atrial disease and not just a precursor to clinical disease. We propose that anticoagulation in SCAF should be guided by integrating arrythmia burden, baseline clinical risk and the degree of structural atrial cardiomyopathy in addition to life expectancy and patient preferences. This review synthesizes data from observational studies, randomized clinical trials, and post-hoc analyses to provide a comprehensive and practical framework for individualized anticoagulation, and risk-benefit considerations.
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Ariaga et al. (2026) conducted a review in Subclinical atrial fibrillation (SCAF). Long-term anticoagulation was evaluated. Anticoagulation in subclinical atrial fibrillation should be guided by arrhythmia burden, clinical risk, atrial cardiomyopathy, life expectancy, and patient preferences.
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