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August 22, 2024Reviews in Cardiovascular MedicineOpen Access

Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions

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Key result

Oral anticoagulants reduce stroke risk in AHRE over six minutes despite increased major bleeding.

Why the study?

Optimal clinical management of subclinical AF and AHREs remains unclear, with no defined episode duration threshold for stroke risk and contrasting randomized trial results regarding anticoagulation benefits.

Does anticoagulation reduce thromboembolic events in asymptomatic patients with CIEDs and AHREs/subclinical AF?

Design

Review

Authors

CBCarola Griffith BrooklesRPRoberto De PontiVRVincenzo Russo

Discussion

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Member takes

Overview

Supports individualized anticoagulation for subclinical AF; leaves open the optimal duration threshold for treatment initiation pending.

Structured PICO

Does anticoagulation reduce thromboembolic events in asymptomatic patients with CIEDs and AHREs/subclinical AF?

P
Population
Asymptomatic patients with cardiac implantable electronic devices (CIEDs) and insertable cardiac monitors (ICMs) experiencing atrial high-rate episodes (AHREs) or subclinical atrial fibrillation (AF).
I
Intervention
Anticoagulation
C
Comparator
No anticoagulation
O
Outcome
Thromboembolic events (e.g., stroke) and cognitive decline

This review highlights that while AHREs and subclinical AF increase thromboembolic and cognitive risks, the optimal threshold for initiating anticoagulation remains a complex, unanswered clinical question.

Limitations

  • Lack of a unanimous cut-off for subclinical arrhythmic events to predict thromboembolic risk
  • Lack of clear temporal relationship between AHREs and stroke

Cite This Study

Brookles et al. (2024) conducted a review in Atrial High-Rate Episodes (AHREs) and Subclinical Atrial Fibrillation. Oral anticoagulants vs. Aspirin or placebo was evaluated. Oral anticoagulants reduce the risk of stroke in patients with atrial high-rate episodes lasting more than 6 minutes, despite an expected increase in major but mostly non-fatal bleeding events.

synapsesocial.com/papers/6a0ef7d325c30b2cc7f9fbc6https://doi.org/10.31083/j.rcm2508305
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Also Consider

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

  1. 1How should I treat patients with subclinical atrial fibrillation and atrial high-rate episodes? Current evidence and clinical importance2022 · 20 citations
  2. 2Antithrombotic therapy in patients with atrial high-rate episodes (AHREs): Current evidence and open questions2024 · 8 citations
  3. 3Management of atrial arrhythmias identified by cardiac devices2024
  4. 4Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?2019 · 39 citations
  5. 5What to do with device‐detected atrial high‐rate episodes: Summary of the evidences2021 · 12 citations