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Review
. 2017 Feb 1;19(2):169-179.
doi: 10.1093/europace/euw279.

Atrial high-rate episodes and stroke prevention

A John Camm  1 , Emmanuel Simantirakis  2 , Andreas Goette  3 , Gregory Y H Lip  4   5 , Panos Vardas  2 , Melanie Calvert  6 , Gregory Chlouverakis  7 , Hans-Christoph Diener  8 , Paulus Kirchhof  9   10
Affiliations
Review

Atrial high-rate episodes and stroke prevention

A John Camm et al. Europace. .

Abstract

While the benefit of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) is well established, it is not known whether oral anticoagulation is indicated in patients with atrial high-rate episodes (AHRE) recorded on a cardiac implantable electronic device, sometimes also called subclinical AF, and lasting for at least 6 min in the absence of clinically diagnosed AF. Clinical evidence has shown that short episodes of rapid atrial tachycarrhythmias are often detected in patients presenting with stroke and transient ischaemic attack. Patients with AHRE have a higher likelihood of suffering from subsequent strokes, but their stroke rate seems lower than in patients with diagnosed AF, and not all AHRE episodes correspond to AF. The prognostic and pathological significance of AHRE is not yet fully understood. Clinical trials of OAC therapy are being conducted to determine whether therapeutic intervention would be beneficial to patients experiencing AHRE in terms of reducing the risk of stroke.

Keywords: Atrial fibrillation; Stroke; Thromboembolic risk; Atrial high-rate episodes; Subclinical atrial fibrillation; Paroxysmal atrial fibrillation; Anticoagulation; Cardiovascular implantable electronic devices.

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Figures

Figure 1
Figure 1
Detection of AF among patients with cryptogenic stroke or transient ischaemic attack randomized to an ICM or control (conventional follow-up). Adapted from Sanna et al.
Figure 2
Figure 2
The MOST study: Kaplan–Meier plot of death or non-fatal stroke after 1 year of the atrial diagnostics ancillary study in patients with atrial high-rate episodes vs. those without atrial high-rate episodes. Source: Glotzer et al.
Figure 3
Figure 3
The TRENDS study: baseline characteristics of study participants. Adapted from Daoud et al.
Figure 4
Figure 4
The TRENDS study: relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli. Source: Brambatti et al.
Figure 5
Figure 5
Suggested treatment algorithm for management of patients with AHREs. Adapted from Kirchhof et al.
See this image and copyright information in PMC

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