What Lies beneath the Surface — Treatment of Subclinical Atrial Fibrillation

This editorial reviews recent evidence on the management of subclinical atrial fibrillation (SCAF), particularly in patients with device-detected atrial high rate episodes (AHREs). Two major randomized trials  NOAH AFNET 6 and ARTESIA evaluated the efficacy and safety of oral anticoagulants in preventing stroke. ARTESIA showed that apixaban significantly reduced stroke and systemic embolism compared to aspirin, though with increased bleeding risk. NOAH AFNET 6, terminated early, found no significant benefit of edoxaban over placebo. The findings underscore the need for individualized treatment decisions balancing stroke prevention against bleeding risk, especially in patients with low AF burden.

This editorial reviews recent evidence on the management of subclinical atrial fibrillation (SCAF), particularly in patients with device-detected atrial high rate episodes (AHREs). Two major randomized trials  NOAH AFNET 6 and ARTESIA evaluated the efficacy and safety of oral anticoagulants in preventing stroke. ARTESIA showed that apixaban significantly reduced stroke and systemic embolism compared to aspirin, though with increased bleeding risk. NOAH AFNET 6, terminated early, found no significant benefit of edoxaban over placebo. The findings underscore the need for individualized treatment decisions balancing stroke prevention against bleeding risk, especially in patients with low AF burden.