Atrial fibrillation (AF) in
the most common cardiac arrhythmia, and is associated with an increased risk of
thromboembolic events. Silent AF is an asymptomatic form of AF incidentally
diagnosed during a routine test or manifesting as an arrhythmia-related
complication. Although recent trials have clearly demonstrated that patients
with sub-clinical AF are at increased risk of stroke, the real incidence of
this form of AF is still unknown. In fact, studies about silent AF had been
performed only in specific subgroups of patients such as those with implantable
cardiac devices, with recent cryptogenic stroke or transient ischemic attack,
and recently undergoing AF ablation. Continuous ECG-monitoring in patients
without implantable cardiac devices may improve silent AF detection but its
cost-effectiveness actually is not well established in all kind of patients.
Moreover, recent data have revealed that only a small number of these patients
may have sub-clinical AF within the month prior to their stroke suggesting a
lack of temporal relationship between the stroke and the AF episode.
paper will review available data on different diagnostic tools for silent AF
detection with a focus on their cost-effectiveness, analyzing the direct
correlation between the arrhythmia and embolic events, and discussing areas of uncertainty where further
research is required.
Credits: Alessandro Barbarossa; Federico Guerra; Alessandro Capucci