Device-Detected Atrial Fibrillation: Evidencing the Knowledge Gap

Stroke is a devastating complication of atrial fibrillation (AF) the odds of which can be reduced by use of oral anticoagulation based on the stroke risk score.1,2 Patients with asymptomatic clinical AF have a similar stroke risk as patients with symptomatic clinical AF.3 Thus far, electrocardiographic- (ECG) or Holter monitor-detected AF is a prerequisite before use of oral anticoagulation,1,2 because the guideline recommendations are based on studies that included only ECG- or Holter-detected AF ('clinical' AF).1,2 In the past decades increasing number of cardiac implantable electronic devices (CIED) have been implanted in patients with cardiovascular diseases, predominantly driven by expanding indications for implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy, and implantable loop recorders. These CIEDs can detect atrial high rate episodes i.e. atrial arrhythmias.4-6 As a consequence of continuous monitoring by these devices, the detection threshold for atrial tachyarrhythmias or AF has decreased dramatically. However, AF-detection algorithms, sensitivity, and specificity vary between CIEDs, and this may have its impact on the usage for AF detection purposes.7.