Clinical significance of atrial fibrillation detected by cardiac implantable electronic devices

The detection of atrial fibrillation (AF) by a cardiac implantable electronic device (CIED) in patients without a prior history of AF is increasing. This trend is the result of the increased number of CIEDs being implanted in a population whose multiple medical comorbidities are known to predispose to AF. Cardiac implantable electronic device–detected atrial fibrillation (CDAF) is independently associated with the development of ischemic stroke, and the annual risk may depend on both total AF burden and individual risk factors. No data evaluating the benefit of oral anticoagulation in this population are available, which makes the decision to initiate anticoagulation challenging. This review analyzes the available data on CDAF and the associated risk of ischemic stroke, and it presents a rationale for the use of long-term oral anticoagulation in this population.