How much subclinical afib does a patient need on their device interrogation to merit starting A/C?
ASSERT initially said six minutes of asymptomatic afib is enough, then a follow-up study pointed to 24h as the threshold. TRENDS suggests 5.5 hours increases risk of embolic events. And a large pooled cohort study (attached) found the highest discriminatory risk to be at the one-hour mark, though event rate was elevated even at five minutes. Clearly the jury is still out, but to me, this data means that any afib lasting longer than 5 minutes deserves a conversation with the patient for joint decision making.
Boriani G, Glotzer TV, Santini M, et al. Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). European Heart Journal. 2014;35(8):508-516. doi:https://doi.org/10.1093/eurheartj/eht491
