[Device-detected atrial arrhythmia - when is anticoagulation indicated?]

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial high rate episodes (AHRE) are common in patients with pacemakers and implantable cardioverter defibrillators.
• AHRE lasting ≥5 minutes correlate with a higher risk of ischemic stroke.
• The direct causal link between AHRE and stroke is unclear, suggesting AHRE may act as a risk marker.

Purpose of the Study:

• To review the current understanding of Atrial High Rate Episodes (AHRE) in patients with cardiac implantable electronic devices.
• To discuss the association between AHRE and ischemic stroke risk.
• To outline current recommendations and ongoing research regarding anticoagulation therapy for AHRE.

Main Methods:

• Literature review of studies on AHRE in patients with pacemakers or implantable cardioverter defibrillators.
• Analysis of the association between AHRE duration and ischemic stroke.
• Examination of European Heart Rhythm Association (EHRA) recommendations for anticoagulation.

Main Results:

• AHRE are frequently detected in patients with cardiac devices.
• Longer AHRE durations (≥5 minutes) are associated with increased ischemic stroke risk.
• No published results exist on anticoagulation's effect in AHRE patients, but studies are ongoing.

Conclusions:

• Anticoagulation is recommended by EHRA for patients with AHRE ≥5.5 hours/day and CHA2DS2-VASc score ≥2 (or ≥3 in females).
• Consideration for anticoagulation may extend to lower CHA2DS2-VASc scores (1 or 2 in females) or shorter AHRE durations if multiple risk factors are present.