Abstract
Cardiovascular implantable electronic devices (CIEDs) can detect atrial arrhythmias, i. e. atrial high-rate episodes (AHRE). The thrombo-embolic risk in patients showing AHRE appears to be lower than in patients with clinical atrial fibrillation (AF) and it is unclear whether the former will benefit from oral anticoagulants. Based on currently available evidence, it seems reasonable to consider antithrombotic therapy in patients without documented AF showing AHRE >24 hours and a CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes mellitus, prior stroke [doubled], vascular disease, age 65–74 years and female sex) ≥1, awaiting definite answers from ongoing randomised clinical trials. In patients with AHRE <24 hours, current literature does not support starting oral anticoagulation. In these patients, intensifying CIED read-outs can be considered to find progression in AHRE duration sooner, enhancing timely stroke prevention. The notion that AHRE and stroke coincide perseveres but should be abandoned since CIED data show a clear disconnect.
Highlights
Cardiovascular implantable electronic devices (CIEDs) with an atrial lead can detect episodes of atrial arrhythmias, regardless of the presence of symptoms
atrial high-rate episodes (AHRE) differ from clinical atrial fibrillation (AF) in the mode of documentation, i. e. clinical AF is ascertained on an electrocardiogram, whereas AHRE are solely recorded on a CIED read-out [7]
It seems logical that a higher AHRE or AF burden is associated with a higher thrombo-embolic risk, which has been shown in the ASSERT trial
Summary
Cardiovascular implantable electronic devices (CIEDs) with an atrial lead can detect episodes of atrial arrhythmias, regardless of the presence of symptoms. Device-detected atrial high-rate episodes (AHRE), in the absence of symptoms referred to as subclinical atrial tachy-arrhythmias, are quite common. The incidence of AHRE in patients without a history of atrial fibrillation (AF) is approximately 25% after 1 year and 35% after 2 years of follow-up [1,2,3]. For patients with a history of AF, the incidence of AHRE is approximately 56–71% after 1 year [4,5,6]. AHRE and AF differ regarding thrombo-embolic risk. In AHRE patients, the thrombo-embolic risk appears to be lower than in clinical AF [2, 6, 9,10,11]. AHRE with a lower mean atrial rate, i. AHRE with a lower mean atrial rate, i. e. 300 bpm
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
