Device-detected atrial fibrillation (AF) is clinically significant because it is associated with an increased risk of stroke and systemic embolism, even when asymptomatic and not previously documented by standard ECG.
The widespread use of cardiac implantable electronic devices (CIEDs) and wearable monitors has revealed that subclinical AF is often brief and asymptomatic, and occurs frequently and may account for a substantial proportion of otherwise unexplained strokes.
The clinical significance of device-detected AF depends on both the duration of the episode and the patient’s CHA₂DS₂-VASc stroke risk score.
Episodes lasting ≥24 hours confer a stroke risk that may warrant oral anticoagulation, while short episodes may not.
The management of device-detected AF remains an area of active research, with ongoing trials aiming to clarify the benefit of anticoagulation in this population.