What is your outpatient approach to monitoring paroxysmal atrial fibrillation (i.e. mobile cardiac telemetry, decision to anticoagulate if high likelihood of recurrence) in young adults with CHADsVASC score of 0, in light of potential remodeling and increased Afib burden as they age?

This is an important question, especially in light of the most recent data suggesting that early maintenance of sinus rhythm is beneficial in patients. If the patient truly has a CHADsVASC score of zero, they have lone atrial fibrillation, low stroke risk, and our major concern is prevention of remodeling leading to increased atrial fibrillation. Things to consider: 1) Patient symptoms; 2) Paroxysmal vs. persistent AF; and 3) Overall burden of AF. While younger patients are less likely to be asymptomatic with atrial fibrillation, it can happen. If they are persistent it can complicate cardioversion as the patient is not anticoagulated and lead to remodeling. Persistence of atrial fibrillation also signals remodeling. Wearable devices or oth...