Publication Name	World Journal of Cardiology
Manuscript ID	111882
Country	India

Category	Cardiac & Cardiovascular Systems
Manuscript Type	Minireviews
Article Title	Subclinical atrial fibrillation: Implications of recent trials for guideline updates?
Manuscript Source	Invited Manuscript
All Author List	Akshyaya Pradhan, Shobhit Shah, Pravesh Vishwakarma and Alok Kumar Singh
Funding Agency and Grant Number
Corresponding Author	Akshyaya Pradhan, Department of Cardiology, King George's Medical University, Shahmina Road, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Key Words	Atrial high-rate episode; NOAH-AFNET 6; ARTESIA; Apixaban; Bleeding; CHA₂DS₂-VASc score
Core Tip	With the growing use of cardiac implantable electronic devices and smartwatches, detection of subclinical atrial fibrillation (SCAF) is common in up to 30% to 60%, depending on the device and the definition used. The risk of stroke in people with SCAF depends on: the baseline CHA₂DS₂-VASc score and how long the episodes last. 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. Recently, two studies have looked into this: the NOAH-AFNET 6 was stopped early because fewer events occurred than expected, and enrollment was slow. In contrast, in the ARTESIA trial, apixaban lowered the risk of stroke and systemic embolism by 37%, though it also led to more bleeding. 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.
Citation	Pradhan A, Shah S, Vishwakarma P, Singh AK. Subclinical atrial fibrillation: Implications of recent trials for guideline updates? World J Cardiol 2025; In press

Received	2025-07-14 05:35
Peer-Review Started	2025-07-14 05:36
To Make the First Decision
Return for Revision	2025-07-30 08:01
Revised	2025-08-12 11:49
Second Decision	2025-11-20 02:37
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-11-20 07:18
Articles in Press	2025-11-20 07:18
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ISSN	1949-8462 (online)
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