Subclinical atrial fibrillation and atrial high-rate episodes are associated with an increased risk of thromboembolic events, particularly when episodes last longer than 24 hours.
Does oral anticoagulation therapy prevent thromboembolic events in patients with subclinical atrial fibrillation and atrial high-rate episodes?
While subclinical AF and AHRE are common and associated with increased stroke risk, their exact temporal relationship to stroke and the optimal threshold for initiating oral anticoagulation require further clarification.
Long-term and continuous ECG monitoring using cardiac implantable electronic devices and insertable cardiac monitors has improved the capability of detecting subclinical atrial fibrillation (AF) and atrial high-rate episodes. Previous studies demonstrated a high prevalence (more than 20%) in patients with cardiac implantable electronic devices or insertable cardiac monitors. Subclinical AF and atrial high-rate episodes are often suspected as the cause of prior or potential future ischemic stroke. However, the clinical significance is still uncertain, and the evidence is limited. This review aims to present and discuss the current evidence on the clinical impact of subclinical AF and atrial high-rate episodes. It focuses particularly on the association between the duration of the episodes and major clinical outcomes like thromboembolic events. As subclinical AF and atrial high-rate episodes are presumed to be associated with ischemic strokes, detection will be particularly important in patients with cryptogenic stroke and in high-risk patients for thromboembolism. In this context, it is also interesting whether there is a temporal relationship between the detection of subclinical AF and atrial high-rate episodes and the occurrence of thromboembolic events. In addition, the review will examine the question whether there is a need for a therapy with oral anticoagulation.
Kreimer et al. (Tue,) conducted a review in Subclinical atrial fibrillation and atrial high-rate episodes. Continuous ECG monitoring and oral anticoagulation was evaluated. Subclinical atrial fibrillation and atrial high-rate episodes are associated with an increased risk of thromboembolic events, particularly when episodes last longer than 24 hours.
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