Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation, but the efficacy and safety of oral anticoagulation for stroke prevention remain unclear.
Does oral anticoagulation reduce the risk of stroke in patients with atrial high-rate episodes (AHRE) without atrial fibrillation?
This review highlights the clinical dilemma of managing atrial high-rate episodes, emphasizing the need for results from ongoing randomized trials to determine if oral anticoagulation is safe and effective for stroke prevention in this population.
Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias detected by continuous rhythm monitoring by pacemakers, defibrillators, or implantable cardiac monitors. Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation. However, it remains unclear whether the presence of these arrhythmias has therapeutic consequences. The presence of AHRE increases the risk of stroke compared with patients without AHRE. Oral anticoagulation would have the potential to reduce the risk of stroke in patients with AHRE but is also associated with a rate of major bleeding of ∼2%/year. The stroke rate in patients with AHRE appears to be lower than the stroke rate in patients with atrial fibrillation. Wearables like smart-watches will increase the absolute number of patients in whom atrial arrhythmias are detected. It remains unclear whether anticoagulation is effective and, equally important, safe in patients with AHRE. Two randomized clinical trials, NOAH-AFNET6 and ARTESiA, are expected to report soon. They will provide much-needed information on the efficacy and safety of oral anticoagulation in patients with AHRE.
Toennis et al. (2023) conducted a review in Atrial high-rate episodes (AHRE). Oral anticoagulation was evaluated. Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation, but the efficacy and safety of oral anticoagulation for stroke prevention remain unclear.