Perspective:

Current guidelines recommend the use of oral anticoagulants for the prevention of thromboembolism irrespective of the type of AF. The guidelines focus on comorbidities, which affect the risk of stroke and thromboembolism. Until recently, it has been very difficult, if not impossible, to know how often and how much AF an individual patient experiences, and analysis of AF duration and outcomes was not done in a longitudinal fashion (i.e., patients labeled as rare paroxysmal may have progressed to frequent or persistent AF during the course of the studies). Our ability to accurately assess the amount of time patients spend in AF has changed overnight with the implantable loop monitors with AF monitoring capabilities. These should be a great tool for prospective studies assessing the risks associated with AF of various durations. The mechanisms by which NPAF patients in this meta-analysis experienced increased mortality are unknown, but include worsened heart failure or perhaps a higher burden of comorbidities. AF may not just be a cause of stroke, but also a marker of greater procoagulant propensity.