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Review
. 2020 Apr;109(4):409-416.
doi: 10.1007/s00392-019-01545-4. Epub 2019 Sep 14.

Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?

Ahsan A Khan  1   2 , Giuseppe Boriani  3 , Gregory Y H Lip  4   5
Affiliations
Review

Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?

Ahsan A Khan et al. Clin Res Cardiol. 2020 Apr.

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.

Keywords: Anticoagulation; Atrial fibrillation; Atrial high rate episodes; Stroke; Thromboembolism.

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Conflict of interest statement

GYHL has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife and Daiichi-Sankyo; and a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. No personal fees received. GB has received small speaker’s fees from Medtronic, Boston, Boehringer, and Bayer, outside of the submitted work. AAK has no conflict of interest.

Figures

Fig. 1
Fig. 1
Proposed flowchart for management of patients with device-detected AHRE [1]
See this image and copyright information in PMC

References

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