Arrhythmias & electrophysiology
Atrial fibrillation progression in patients with device-detected subclinical atrial fibrillation: Insights from the ARTESiA trial
Authors' conclusion
SCAF progression occurred in >9% of patients per year and was associated with a doubling of the risk of all-cause mortality, driven by increases in both heart failure-related and arrhythmic deaths. Patients who remained on aspirin after SCAF progression had an annual rate of stroke/systemic embolism of 1.42%, which is higher than the threshold currently proposed for oral anticoagulant prophylaxis.
Study context
- Population
- Patients with device-detected subclinical AF (subclinical atrial fibrillation (SCAF)) lasting < 24 hours
- Participants
- 4,012 patients
- Comparison
- SCAF progression vs no SCAF progression
- SCAF progressionn = 1,250
- Primary endpoint
- Association of SCAF progression (to clinical AF or SCAF > 24 hours) with adverse outcomes; predictors of SCAF progression
- Follow-up
- 4.1 ± 1.7 years
Primary result
As reported in the abstract
follow-up 4.1 ± 1.7 years
SCAF progression vs No SCAF progressionHazard ratio (95% CI)
All-cause death
2.12(1.83–2.45)
HF death
4.81(3.19–7.27)
Arrhythmic death
2.62(1.58–4.35)
- SCAF progressed (patients)
- 1250 of 4012 (31.2%)
- Rate of SCAF progression
- 9.3% per patient-year
Further findings
Stroke/systemic embolism on blinded aspirin after SCAF progression
Per patient-year
- Rate, progression to clinical AF or SCAF > 24 hours
- 1.42%
- Rate, progression limited to SCAF > 24 hours
- 1.75%
Baseline predictors of SCAF progression
- C statistic
- 0.59 (95% CI 0.57-0.61)
- Age, HR per year
- 1.02 (95% CI 1.01-1.03)
- Male sex, HR
- 1.30 (95% CI 1.14-1.47)
- HF, HR
- 1.28 (95% CI 1.13-1.46)
- DM, HR
- 1.18 (95% CI 1.04-1.34)
- Left atrial diameter > 4.1 cm, HR
- 1.28 (95% CI 1.08-1.52)
- Longest baseline SCAF episode > 1 hour, HR
- 1.59 (95% CI 1.42-1.79)
Original publication
Atrial fibrillation progression in patients with device-detected subclinical atrial fibrillation: Insights from the ARTESiA trial. Heart Rhythm. Published 9 July 2025. doi:10.
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