Device-identified atrial fibrillation at pacing clinics. Should it guide anticoagulation?

•Silent atrial fibrillation is common and leads to significant comorbidity.•Implantable devices such as pacemakers can help detect silent atrial fibrillation.•Anticoagulation should be considered in all patients with silent atrial fibrillation detected during a pacing check.•Especially for patients at high thromboembolic risk, anticoagulation might improve prognosis.

In recent years, there has been a significant increase in the number of devices implanted following improvement in their safety profile, extension of indications and reduction in cost. Although the reason remains largely the beneficial effect on heart rhythm stabilisation, implanted devices might also have additional advantages, notably identification of silent arrhythmia. Should clinicians therefore act on device-identified atrial fibrillation (AF) and should such identification be used to guide anticoagulation management? This review evaluates the current evidence on the management of device-identified asymptomatic AF.