Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach
Issued Date
2025-12-01
Resource Type
eISSN
26666065
Scopus ID
2-s2.0-105024199495
Journal Title
Lancet Regional Health Western Pacific
Volume
65
Rights Holder(s)
SCOPUS
Bibliographic Citation
Lancet Regional Health Western Pacific Vol.65 (2025)
Suggested Citation
Chao T.F., Lau C.P., Choi E.K., Ching C.K., Chan N.Y., Hung C.L., Joung B., Krittayaphong R., Tse H.F., Lip G.Y.H. Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach. Lancet Regional Health Western Pacific Vol.65 (2025). doi:10.1016/j.lanwpc.2025.101770 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113524
Title
Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach
Author's Affiliation
The University of Hong Kong
University of Liverpool
Aalborg University
Yonsei University College of Medicine
Seoul National University College of Medicine
Taipei Veterans General Hospital
Seoul National University Hospital
National Yang Ming Chiao Tung University
Siriraj Hospital
Uniwersytet Medyczny w Bialymstoku
Mackay Memorial Hospital Taiwan
MacKay Medical University
National Heart Centre Singapore
Princess Margaret Hospital Hong Kong
University of Liverpool
Aalborg University
Yonsei University College of Medicine
Seoul National University College of Medicine
Taipei Veterans General Hospital
Seoul National University Hospital
National Yang Ming Chiao Tung University
Siriraj Hospital
Uniwersytet Medyczny w Bialymstoku
Mackay Memorial Hospital Taiwan
MacKay Medical University
National Heart Centre Singapore
Princess Margaret Hospital Hong Kong
Corresponding Author(s)
Other Contributor(s)
Abstract
Device-detected atrial fibrillation (DDAF), including atrial high-rate episodes recorded at a cardiovascular implantable electronic device and subclinical atrial fibrillation detected by insertable cardiac monitor and smart wearables, poses an increasing challenge in stroke prevention. Although oral anticoagulants (OACs) are effective in clinical AF, their benefit-risk balance in DDAF remains uncertain. In response, the Asia Pacific Heart Rhythm Society (APHRS) proposes the 4S-DDAF approach (Strip documentation and longest AF duration, Symptoms, Stroke [ischemic] history, and Score) to guide anticoagulation decisions. This approach integrates electrogram review, symptom assessment, history of ischemic stroke or transient ischemic attack (TIA), and CHA<inf>2</inf>DS<inf>2</inf>-VASc scoring, emphasizing individualized care. OACs are recommended for patients with AF episodes ≥24 h, prior stroke/TIA, CHA<inf>2</inf>DS<inf>2</inf>-VASc score ≥4, or vascular disease. In patients not meeting these thresholds, close monitoring and risk factor management are advised. The 4S-DDAF approach provides a practical and evidence-informed strategy for clinical decision-making in the management of DDAF.