Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence

Emanuele Bertaglia, Benjamin Blank, Carina Blomström-Lundqvist, Axel Brandes, Nuno Cabanelas, G. Andrei Dan, Wolfgang Dichtl, Andreas Goette, Joris R. de Groot, Andrzej Lubinski, Eloi Marijon, B. Merkely, Lluis Mont, Christopher Piorkowski, Andrea Sarkozy, Neil Sulke, Panos Vardas, Vasil Velchev, Dan Wichterle, Paulus Kirchhof

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Self-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10-30% of AF-free patients. Presence of AHRE slightly increases stroke risk (0.8% to 1%/year) compared with patients without AHRE. Atrial high-rate episode of longer duration (e.g. those >24 h) could be associated with a higher stroke risk. Oral anticoagulation has the potential to reduce stroke risk in patients with AHRE but is associated with a rate of major bleeding of 2%/year. Oral anticoagulation is not effective in patients with heart failure or survivors of a stroke without AF. It remains unclear whether anticoagulation is effective and safe in patients with AHRE. Atrial high-rate episodes are common and confer a slight increase in stroke risk. There is true equipoise on the best way to reduce stroke risk in patients with AHRE. Two ongoing trials (NOAH-AFNET 6 and ARTESiA) will provide much-needed information on the effectiveness and safety of oral anticoagulation using non-vitamin K antagonist oral anticoagulants in patients with AHRE.

Fingerprint

Risk Management
Stroke
Atrial Fibrillation
Cardiac Arrhythmias
Defibrillators
Anticoagulants
Survivors
Heart Failure
Hemorrhage
Safety

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Atrial high-rate episodes
  • Continuous monitoring
  • Pacemaker
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atrial high-rate episodes : prevalence, stroke risk, implications for management, and clinical gaps in evidence. / Bertaglia, Emanuele; Blank, Benjamin; Blomström-Lundqvist, Carina; Brandes, Axel; Cabanelas, Nuno; Dan, G. Andrei; Dichtl, Wolfgang; Goette, Andreas; de Groot, Joris R.; Lubinski, Andrzej; Marijon, Eloi; Merkely, B.; Mont, Lluis; Piorkowski, Christopher; Sarkozy, Andrea; Sulke, Neil; Vardas, Panos; Velchev, Vasil; Wichterle, Dan; Kirchhof, Paulus.

In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 21, No. 10, 01.10.2019, p. 1459-1467.

Research output: Contribution to journalArticle

Bertaglia, E, Blank, B, Blomström-Lundqvist, C, Brandes, A, Cabanelas, N, Dan, GA, Dichtl, W, Goette, A, de Groot, JR, Lubinski, A, Marijon, E, Merkely, B, Mont, L, Piorkowski, C, Sarkozy, A, Sulke, N, Vardas, P, Velchev, V, Wichterle, D & Kirchhof, P 2019, 'Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 21, no. 10, pp. 1459-1467. https://doi.org/10.1093/europace/euz172
Bertaglia, Emanuele ; Blank, Benjamin ; Blomström-Lundqvist, Carina ; Brandes, Axel ; Cabanelas, Nuno ; Dan, G. Andrei ; Dichtl, Wolfgang ; Goette, Andreas ; de Groot, Joris R. ; Lubinski, Andrzej ; Marijon, Eloi ; Merkely, B. ; Mont, Lluis ; Piorkowski, Christopher ; Sarkozy, Andrea ; Sulke, Neil ; Vardas, Panos ; Velchev, Vasil ; Wichterle, Dan ; Kirchhof, Paulus. / Atrial high-rate episodes : prevalence, stroke risk, implications for management, and clinical gaps in evidence. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2019 ; Vol. 21, No. 10. pp. 1459-1467.
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