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Assessment and management of asymptomatic atrial fibrillation
  1. Jason G. Andrade1,2,3,
  2. Marc W. Deyell1,2,
  3. Richard Bennett1,2,
  4. Laurent Macle3
  1. 1 Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
  3. 3 Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
  1. Correspondence to Dr Jason G. Andrade, Division of Cardiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; jason.andrade{at}


Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia encountered in practice. It is currently estimated that AF affects approximately 2% of the general population; however, the true prevalence of AF is likely to be at least 3%–4% when asymptomatic AF is considered. For clinically apparent AF, the investigations and management are relatively well established. The identification of minimally symptomatic patients is challenging, and furthermore, the optimal management is less certain. Although there is some debate about the ideal treatment pathway for asymptomatic AF, in most cases, the investigations and comprehensive management follow the same recommendations as clinically apparent AF. In contrast, beyond risk factor optimisation, the ideal management of subclinical or device-detected AF remains undefined. The purpose of the current review is to discuss the assessment and management of asymptomatic AF.

  • Atrial Fibrillation
  • Stroke

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  • X @drJasonAndrade

  • Contributors Conception and first draft: JA. Critical revision: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JA reports grants and personal fees from Medtronic, grants from Baylis and personal fees from Biosense-Webster; MD reports grants from Biosense-Webster, personal fees from Medtronic, and grants and personal fees from St. Jude Medical/Abbott and Biosense-Webster; RB has nothing to disclose.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include * are considered to be key references.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.