Device-detected, subclinical atrial fibrillation (AF), previously known as atrial high-rate episodes, is detected in roughly one-third of older patients with a pacemaker, defibrillator, or implanted cardiac monitor [1]. Device-detected subclinical AF is associated with an increased risk of ischemic stroke; however, this risk is lower than in otherwise similar patients with overt clinical AF on 12-lead electrocardiogram [1,2]. Two large randomized trials have recently addressed the question of whether a direct oral anticoagulant is effective and safe in this population [3–5].
