Stroke risk in patients with device-detected atrial high-rate episodes

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Cardiovascular implantable electronic devices (CIEDs) detect atrial high-rate episodes (AHRE).
• Thrombo-embolic risk associated with AHRE is less understood compared to clinical atrial fibrillation (AF).
• Optimal management of AHRE regarding oral anticoagulation remains unclear.

Purpose of the Study:

• To evaluate the current evidence on antithrombotic therapy for patients with AHRE.
• To provide guidance on managing AHRE based on episode duration and patient risk factors.
• To address the misconception of a direct link between AHRE and stroke.

Main Methods:

• Review of current literature and evidence regarding AHRE and thrombo-embolic events.
• Analysis of risk stratification using CHA2DS2-VASc score in patients with AHRE.
• Consideration of data from ongoing randomized clinical trials.

Main Results:

• Antithrombotic therapy may be considered for AHRE >24 hours in patients with CHA2DS2-VASc score ≥1.
• Current evidence does not support oral anticoagulation for AHRE <24 hours.
• CIED data indicate a disconnect between AHRE occurrence and concurrent stroke.

Conclusions:

• Management strategies for AHRE should differentiate based on episode duration.
• Close monitoring of CIED data can facilitate timely stroke prevention for shorter AHRE episodes.
• Further research through randomized trials is crucial for definitive treatment guidelines.