Key result
Short AHRE under 24 hours is linked to a ~7-fold higher risk of stroke or TIA.
Why the study?
To assess the risk of stroke/TIA and progression to AF in Indian patients with device-detected atrial high-rate episodes lasting less than 24 hours.
Does device-detected AHRE < 24 hours increase the risk of stroke/TIA and progression to clinical AF in Indian patients with cardiac implantable devices?
Cohort (n=218)
No
Does device-detected AHRE < 24 hours increase the risk of stroke/TIA and progression to clinical AF in Indian patients with cardiac implantable devices?
Odds Ratio: 7.41 (95% CI 0.9–61.3)
Absolute Event Rate: 4.28% vs 0.61%
p-value: p=0.020
Device-detected AHRE lasting less than 24 hours is associated with a significantly increased risk of stroke/TIA and progression to clinical AF, suggesting these short episodes are not benign in high-risk patients.
Short AHRE <24h associated with higher stroke risk; hypothesis-generating and should not yet change anticoagulation practice.
Aims To assess the risk of stroke/TIA and progression to atrial fibrillation (AF) in Indian patients with device‐detected atrial high‐rate episodes (AHRE) lasting less than 24 h. Methods and Results In this single‐centre prospective matched cohort study, 109 patients with AHRE < 24 h matched to 109 controls without AHRE on age (+/−5 years), sex, device type, device indication, and CHA2DS2‐VASc score. Followed for a minimum of 12 months (mean 18.4 months). The CHA2DS2‐VASc score was near‐perfectly matched between groups (mean 3.26 vs. 3.29, score distribution chi‐square p = 1.00). A stroke or TIA occurred in 7 patients with AHRE versus 1 control (annual rate 4.28% vs. 0.61%; OR 7.41, 95% CI 0.90–61.3; p = 0.020; HR 7.19, 95% CI 0.89–58.48; log‐rank p = 0.031). Progression to clinical AF, AHRE ≥ 24 h, atrial flutter, or atrial tachycardia happened in 32 AHRE patients versus 2 controls (annual rate 19.7% vs. 1.2%; OR 22.2, 95% CI 5.17–95.6; HR 19.55, 95% CI 4.6–81.71; log rank p < 0.001). Stroke risk increased with CHA 2 DS 2 ‐VASc score: 2.15% (score 3), 4.16% (score 4), 6.66% (score 5), and 9.5% (score ≥ 6). Conclusion In this hypothesis‐generating study, device‐detected AF lasting less than 24 h is associated with a significantly higher risk of stroke/TIA and progression to clinical AF in Indian patients. It requires confirmation in larger studies. Region‐specific absolute risks must be considered when applying international anticoagulation guidelines.
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Shanmugam et al. (2026) conducted a cohort in Patients with cardiac implantable electronic devices (n=218). Device-detected atrial high-rate episodes (AHRE) < 24 hours vs. Matched controls without AHRE was evaluated on Ischemic stroke or TIA (OR 7.41, 95% CI 0.90-61.3, p=0.020). Device-detected atrial high-rate episodes lasting less than 24 hours were associated with a significantly higher risk of stroke or TIA (OR 7.41) compared to matched controls without AHRE.
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