Device-detected subclinical atrial fibrillation (SCAF) should be treated like clinical atrial fibrillation (AF). This debate focuses on whether SCAF, detected by cardiac implantable electronic devices (CIEDs), should be managed similarly to clinical AF due to its potential risks, including stroke and thromboembolism. SCAF is defined as asymptomatic AF episodes confirmed by visual review of CIED tracings, while clinical AF is symptomatic or asymptomatic AF of at least 30 seconds documented by surface ECG. A meta-analysis of 54 studies found that SCAF prevalence is 28.1%, with higher rates in older patients with multiple comorbidities and increased thromboembolic risk. Several studies have shown that SCAF is associated with an increased risk of stroke, cardiovascular mortality, and all-cause mortality. The STROKESTOP trial found that screening for asymptomatic AF reduced the risk of stroke, systemic embolism, death, and bleeding. The LOOP study also showed a benefit of screening, although the results were not as strong as in STROKESTOP. The ASSERT study found that SCAF episodes lasting more than 6 minutes were associated with a 2.5-fold increased risk of stroke. However, the risk of stroke in patients with SCAF is lower than in those with clinical AF. The risk of bleeding with oral anticoagulation (OAC) is a major concern, with studies showing a bleeding risk of 3-5%. Recent trials, such as NOAH-AFNET 6 and ARTESIA, have shown that OAC reduces the risk of stroke and systemic embolism but increases the risk of bleeding. Despite these findings, the management of SCAF should be personalized, balancing the risks and benefits of OAC initiation and identifying factors that drive AF progression. The debate centers on whether SCAF should be treated like clinical AF. Proponents argue that SCAF episodes, especially those lasting more than 24 hours, should be treated similarly to clinical AF due to their association with increased stroke risk. However, opponents argue that the stroke risk in SCAF is lower than in clinical AF and that the low stroke rate in SCAF episodes suggests that they may not require the same level of intervention as clinical AF. The decision to treat SCAF should consider the patient's overall risk profile, including comorbidities and AF burden, and the potential benefits and risks of OAC therapy. The management of SCAF should be individualized, with a focus on preventing stroke and other complications while minimizing the risk of bleeding.Device-detected subclinical atrial fibrillation (SCAF) should be treated like clinical atrial fibrillation (AF). This debate focuses on whether SCAF, detected by cardiac implantable electronic devices (CIEDs), should be managed similarly to clinical AF due to its potential risks, including stroke and thromboembolism. SCAF is defined as asymptomatic AF episodes confirmed by visual review of CIED tracings, while clinical AF is symptomatic or asymptomatic AF of at least 30 seconds documented by surface ECG. A meta-analysis of 54 studies found that SCAF prevalence is 28.1%, with higher rates in older patients with multiple comorbidities and increased thromboembolic risk. Several studies have shown that SCAF is associated with an increased risk of stroke, cardiovascular mortality, and all-cause mortality. The STROKESTOP trial found that screening for asymptomatic AF reduced the risk of stroke, systemic embolism, death, and bleeding. The LOOP study also showed a benefit of screening, although the results were not as strong as in STROKESTOP. The ASSERT study found that SCAF episodes lasting more than 6 minutes were associated with a 2.5-fold increased risk of stroke. However, the risk of stroke in patients with SCAF is lower than in those with clinical AF. The risk of bleeding with oral anticoagulation (OAC) is a major concern, with studies showing a bleeding risk of 3-5%. Recent trials, such as NOAH-AFNET 6 and ARTESIA, have shown that OAC reduces the risk of stroke and systemic embolism but increases the risk of bleeding. Despite these findings, the management of SCAF should be personalized, balancing the risks and benefits of OAC initiation and identifying factors that drive AF progression. The debate centers on whether SCAF should be treated like clinical AF. Proponents argue that SCAF episodes, especially those lasting more than 24 hours, should be treated similarly to clinical AF due to their association with increased stroke risk. However, opponents argue that the stroke risk in SCAF is lower than in clinical AF and that the low stroke rate in SCAF episodes suggests that they may not require the same level of intervention as clinical AF. The decision to treat SCAF should consider the patient's overall risk profile, including comorbidities and AF burden, and the potential benefits and risks of OAC therapy. The management of SCAF should be individualized, with a focus on preventing stroke and other complications while minimizing the risk of bleeding.