Device-detected atrial tachyarrhythmias: what do we know?

Abstract

This editorial refers to ‘Detection of atrial high-rate events by continuous Home Monitoring: clinical significance in the heart failure–cardiac resynchronization therapy population’ by N. Shanmugam et al. , on page 230 Depending on one's perspective, modern pacemakers and defibrillators provide physicians with a wealth or burden of diagnostic information. Currently, there is great interest in the ability of these devices to monitor thoracic impedance, ST-segments, and other physiological parameters.1,2 However, the ability to document and characterize otherwise undetected atrial tachyarrhythmias, referred to as atrial high-rate episodes (AHRE), has been available for >10 years.3 Despite this familiarity with AHRE, there remains a formidable knowledge gap which stands between physicians and the optimal use of these data for patient care. As paroxysmal atrial fibrillation appears to pose the same risk of stroke as sustained episodes,4 it is tempting to simply assume that AHRE should be managed like conventionally diagnosed atrial fibrillation. However, these otherwise silent atrial tachyarrhythmias may have a significantly different prognosis and the impact of prophylactic oral anticoagulation may be quite different in this population. The ASSERT (A Symptomatic Stroke and atrial fibrillation Evaluation …