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June 18, 2024Arrhythmia & Electrophysiology ReviewOpen Access

Device-detected AHRE linked to ~233% greater risk of clinical AF and thromboembolic events.

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Why the study?

Outcomes of device-detected AF remain unclear in individuals without a prior history of AF.

Does device-detected atrial fibrillation increase the risk of clinical AF, thromboembolism, and mortality in individuals with no prior history of AF?

Population

Individuals with no prior history of AF

Comparison

Device-detected AF vs no device-detected AF

Design

Systematic review and meta-analysis

Key result

Device-detected atrial high-rate episodes significantly increased the risk of clinical atrial fibrillation (RR 3.33) and thromboembolic events (RR 2.21) in patients with no prior history of AF.

Authors

HAHasaan AhmedMIMahmoud IsmaylAPAnirudh Palicherla

Discussion

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Overview

Supports intensified monitoring for clinical AF and thromboembolism; confirms associations and leaves optimal anticoagulation strategies open.

Study Design

Type

Meta-Analysis (n=7,440)

Structured PICO

Does device-detected atrial fibrillation increase the risk of clinical AF, thromboembolism, and mortality in individuals with no prior history of AF?

P
Population
Individuals with no prior history of atrial fibrillation
I
Intervention
Device-detected atrial fibrillation (atrial high-rate episodes)
C
Comparator
Individuals who did not experience device-detected atrial fibrillation
O
Outcome
Clinical AF, thromboembolism, and all-cause mortalityhard clinical

Main Result

Effect estimate: RR 3.33 (95% CI 1.99-5.57)

p-value: p=<0.0001

Device-detected atrial high-rate episodes in patients without prior AF are associated with a significantly increased risk of subsequent clinical AF and thromboembolism, particularly when episodes last >24 hours.

Limitations

  • Possibility of undiagnosed or paroxysmal AF not known to patients or providers.
  • Severe cardiac comorbidities warranting CIEDs may have amplified the risk of arrhythmias and thromboembolism.
  • Timespan of outcomes assessed was limited as certain studies ended prematurely.
  • Variability in the definitions of AHREs and outcomes between the individual studies.

Cite This Study

Ahmed et al. (2024) conducted a meta-analysis in Device-detected Atrial High-rate Episodes (AHREs) without prior history of Atrial Fibrillation (n=7,440). Device-detected Atrial High-rate Episodes (AHREs) vs. No device-detected Atrial High-rate Episodes was evaluated on Clinical Atrial Fibrillation (RR 3.33, 95% CI 1.99-5.57, p=<0.0001). Device-detected atrial high-rate episodes significantly increased the risk of clinical atrial fibrillation (RR 3.33) and thromboembolic events (RR 2.21) in patients with no prior history of AF.

synapsesocial.com/papers/6a08aaf8280cd4e998e8d7d6https://doi.org/10.15420/aer.2024.11
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1F-1 | Outcomes of Cardiac Implantable Electronic Device-Detected Subclinical Atrial Fibrillation and Role of Anticoagulation: A Meta-Analysis2024
  2. 2Device-Detected Atrial High-Rate Episodes and Risk of Ischaemic Stroke and Progression to Atrial Fibrillation: A Systematic Review and Meta-Analysis2026
  3. 3Subclinical Atrial Fibrillation and Anticoagulation: Weighing the Absolute Risks and Benefits2024 · 13 citations
  4. 4Incidence of Newly Detected Atrial Arrhythmias via Implantable Devices in Patients With a History of Thromboembolic Events2010 · 173 citations
  5. 5Anticoagulation in Patients With Device‐Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH‐AFNET 6 Trial2024 · 30 citations