The article discusses the debate on whether device-detected subclinical atrial fibrillation (SCAF) should be treated like clinical atrial fibrillation (AF). The authors, Prashanthan Sanders and colleagues, argue that SCAF should be managed as if it were clinical AF due to its potential to progress to clinical AF and the associated increased risk of stroke. They highlight that SCAF episodes, often asymptomatic, can be detected by cardiac implantable electronic devices (CIEDs) and are associated with a higher risk of stroke compared to clinical AF. Studies such as the ASSERT trial and meta-analyses have shown that SCAF episodes lasting ≥6 minutes are linked to a higher risk of stroke, even though the risk is lower than in patients with clinical AF. The authors also emphasize the importance of comorbidities and the progressive nature of AF, suggesting that SCAF should be treated similarly to clinical AF to reduce the risk of severe strokes. In contrast, Søren Z. Diederichsen and colleagues argue that SCAF should not be treated as clinical AF. They point out that the stroke rate in patients with device-detected AF is lower compared to clinical AF, and that randomized trials like NOAH-AFNET 6 and ARTESIA have not convincingly demonstrated a net benefit of anticoagulation for SCAF. They also highlight the lack of a clear temporal relationship between AF and stroke in many cases, and the potential for AF to resolve spontaneously. The authors suggest that efforts to manage SCAF should not overshadow the care of other, more well-described risk factors, such as hypertension, and that the focus should be on optimizing cardiovascular and comorbidity management. The debate centers on the clinical significance of SCAF and the optimal management approach, particularly regarding oral anticoagulation (OAC) therapy. The authors conclude that while SCAF should be managed with caution, the evidence for treating it as clinical AF is lacking, and potential harm from aggressive anticoagulation should be considered.The article discusses the debate on whether device-detected subclinical atrial fibrillation (SCAF) should be treated like clinical atrial fibrillation (AF). The authors, Prashanthan Sanders and colleagues, argue that SCAF should be managed as if it were clinical AF due to its potential to progress to clinical AF and the associated increased risk of stroke. They highlight that SCAF episodes, often asymptomatic, can be detected by cardiac implantable electronic devices (CIEDs) and are associated with a higher risk of stroke compared to clinical AF. Studies such as the ASSERT trial and meta-analyses have shown that SCAF episodes lasting ≥6 minutes are linked to a higher risk of stroke, even though the risk is lower than in patients with clinical AF. The authors also emphasize the importance of comorbidities and the progressive nature of AF, suggesting that SCAF should be treated similarly to clinical AF to reduce the risk of severe strokes. In contrast, Søren Z. Diederichsen and colleagues argue that SCAF should not be treated as clinical AF. They point out that the stroke rate in patients with device-detected AF is lower compared to clinical AF, and that randomized trials like NOAH-AFNET 6 and ARTESIA have not convincingly demonstrated a net benefit of anticoagulation for SCAF. They also highlight the lack of a clear temporal relationship between AF and stroke in many cases, and the potential for AF to resolve spontaneously. The authors suggest that efforts to manage SCAF should not overshadow the care of other, more well-described risk factors, such as hypertension, and that the focus should be on optimizing cardiovascular and comorbidity management. The debate centers on the clinical significance of SCAF and the optimal management approach, particularly regarding oral anticoagulation (OAC) therapy. The authors conclude that while SCAF should be managed with caution, the evidence for treating it as clinical AF is lacking, and potential harm from aggressive anticoagulation should be considered.