Screening and clinical implications of silent atrial fibrillation

Each year, 5 million new cases of atrial fibrillation (AF) are diagnosed, and the data for the last 20 years show that its incidence has continued to grow. The aging of the population is considered a major explanation for this pandemic phenomenon. The complications associated with atrial arrhythmia are numerous and frequent, with in the first place thromboembolic events. In addition to symptomatic atrial fibrillation, AF may be diagnosed by chance during a systematic ECG, an external Holter or a continuous ECG monitor, or in the memories of implanted cardiac devices. This is called silent AF. Despite numerous studies, silent AF is still largely under-diagnosed and unrecognized in everyday clinical practice, although it is a frequent condition with potentially serious consequences (especially thromboembolic events). Thanks to the development of new diagnostic tools, which are scientifically validated and readily available, the detection of AF has improved significantly, leading to better therapeutic management, in particular anticoagulant therapy. From this perspective, mass screening for silent AF using these new technologies is a major step forward in e-health development. The cost of screening and the heterogeneity of populations affected by silent AF, however, remain major obstacles. (C) 2017 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.