Device-Detected Atrial Fibrillation-Perils and Pitfalls: An Update

Stroke and thromboembolism are catastrophic complications of atrial fibrillation (AF). Cardiac implantable electronic devices (CIED) with an atrial lead can reliably detect atrial high-rate events (AHRE). However, this correlation may be imperfect because of oversensing and undersensing of atrial signals and spurious arrhythmias. The critical duration, frequency, or overall burden of AHRE that increases stroke risk is still unknown; thus, the threshold level of AHRE (duration and frequency) that warrants anticoagulation in patients with CIED-detected AHRE is still unclear. This article reviews current literature on the risk of stroke with CIED-detected AHRE and raises questions that need further clarification.