The detection of subclinical, or “silent,” atrial fibrillation (AFib) has increased substantially with the widespread use of implantable devices (e.g., pacemakers, defibrillators) and consumer wearables such as smartwatches. A key clinical question is the threshold of cumulative AFib burden—such as duration identified on device interrogation—at which anticoagulation should be considered. Additionally, clinicians should consider when consumer wearable rhythm monitoring is appropriate, such as in patients with symptoms or elevated stroke risk. Best practices are needed to guide counseling and management of patients with subclinical AFib, including when to initiate stroke and systemic embolism prevention strategies.

In this interview, W. Douglas Weaver MD, MACC and Deepak Bhakta, MD, MBA, FACC discuss managing subclinical AFib detected by devices, ambulatory monitors and wearables.