September 14, 2019Clinical Research in Cardiology39 citationsOpen Access
Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?
Key Result
Atrial high rate episodes detected by cardiac implantable electronic devices are associated with an increased risk of thromboembolism, though lower than clinical atrial fibrillation.
Structured PICO
P
Population
Patients with cardiac implantable electronic devices (CIEDs) detecting atrial high rate episodes (AHREs)
Device-detected atrial high rate episodes are associated with an elevated risk of stroke and MACE, highlighting the need for individualized stroke risk assessment while awaiting definitive trial data on the efficacy of oral anticoagulation.
Limitations
- Lack of concrete evidence for a temporal relationship between AHRE and stroke
- Sparse evidence on the critical threshold for duration/number of AHRE burden
- Absence of studies demonstrating benefit of oral anticoagulation therapy in patients with device-detected AHRE
- Various definitions of AHRE used in past studies
Abstract
Atrial high rate episodes (AHREs), also termed, subclinical atrial tachyarrhythmias or subclinical atrial fibrillation (AF) are an important cardiovascular condition. Advancement in implantable cardiac devices such as pacemakers or internal cardiac defibrillators has enabled the continuous assessment of atrial tachyarrhythmias in patients with an atrial lead. Patients with device-detected AHREs are at an elevated risk of stroke and may have unmet anticoagulation needs. While the benefits of oral anticoagulation for stroke prevention in patients with clinical AF are well recognised, it is not known whether the same risk-benefit ratio exists for anticoagulation therapy in patients with AHREs. The occurrence and significance of AHRE are increasingly acknowledged but these events are still not often acted upon in patients presenting with stroke and TIA. Additionally, patients with AHRE show a significant risk for major adverse cardiovascular events (MACE) including acute heart failure, myocardial infarction, cardiovascular hospitalisation, ventricular tachycardia/fibrillation, which is dependent on AHRE burden. In this review, we present an overview of this relatively new entity, its associated thromboembolic risk and its management implications.
Cite This Study
Khan et al. (2019) conducted a review in Atrial high rate episodes (AHREs). Atrial high rate episodes detected by cardiac implantable electronic devices are associated with an increased risk of thromboembolism, though lower than clinical atrial fibrillation.