Pradhan A, Shah S, Vishwakarma P, Singh AK. Subclinical atrial fibrillation: Implications of recent trials for guideline updates? World J Cardiol 2026; 18(1): 111882 [DOI: 10.4330/wjc.v18.i1.111882]
Corresponding Author of This Article
Akshyaya Pradhan, Professor, Department of Cardiology, King George's Medical University, Shahmina Road, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Co-first authors: Akshyaya Pradhan and Shobhit Shah.
Author contributions: Pradhan A and Shah S conceived the project; Pradhan A and Vishwakarma P performed the literature search; Pradhan A and Shah S prepared the first draft and Singh AK critically reviewed it; Pradhan A and Vishwakarma P performed the journal search; Pradhan A and Shah S did the submission; Vishwakarma P and Shah S prepared the revised version while Pradhan A and Singh AK resubmitted it. Pradhan A and Shah S contributed equally to this work as co-first authors.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akshyaya Pradhan, Professor, Department of Cardiology, King George's Medical University, Shahmina Road, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Received: July 14, 2025 Revised: August 12, 2025 Accepted: November 20, 2025 Published online: January 26, 2026 Processing time: 187 Days and 20.1 Hours
Core Tip
Core Tip: The risk of stroke in people with subclinical atrial fibrillation (SCAF) depends on: The baseline CHA2DS2-VASc score and the duration of the episodes. Short episodes-those lasting less than six minutes-are generally of uncertain significance. However, when the episodes last longer than 24 hours, the risk of stroke or systemic embolism increases more than threefold. The utility of oral anticoagulation, for preventing stroke in those with SCAF is still under debate. According to current ACC/AHA guidelines, oral anticoagulation is recommended for people who have SCAF episodes lasting more than 24 hours and have a high CHA2DS2-VASc score. For those with episodes between six minutes and 24 hours, a more cautious approach is advised-this includes managing risk factors along with regular follow-up. However, the positive results from the ARTESIA study suggest these recommendations may need to be reconsidered.
