What considerations should be taken into account when making decisions about anticoagulation in patients who present with a clinically documented episode of AF?
For patients who present with a clinically documented episode of AF (12-lead ECG or other means, eg, external devices with validated rhythm detection), the presence or absence of symptoms must not influence the process of decision-making with regard to the need for anticoagulation based on risk stratification. In cases of AHRE (atrial high-rate episodes) detected by a CIED of at least 5 min duration, direct analysis of electrograms corresponding to AHRE is clinically indicated to exclude artifacts or other causes of inappropriate detection of atrial tachyarrhythmias or AF. For patients with AF, prescription of oral anticoagulants could be considered as a result of an individualized clinical assessment taking into account overall AHRE burden (in the range of hours rather than minutes), the presence of AHRE > 24 h, individual stroke risk (using CHA2DS2-VASc), predicted risk benefit of oral anticoagulation and informed patient preferences. 