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

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial high rate episodes (AHREs), also known as subclinical atrial tachyarrhythmias or atrial fibrillation (AF), are increasingly detected by advanced implantable cardiac devices.
• Device-detected AHREs are associated with an elevated risk of stroke and major adverse cardiovascular events (MACE).
• The clinical significance and optimal management of AHREs, particularly regarding anticoagulation, remain areas of active investigation.

Purpose of the Study:

• To provide a comprehensive overview of atrial high rate episodes (AHREs).
• To discuss the thromboembolic risks associated with AHREs.
• To explore the management implications of AHREs in clinical practice.

Main Methods:

• This review synthesizes current literature on device-detected atrial tachyarrhythmias.
• It examines data regarding the association between AHREs and cardiovascular outcomes.
• The review discusses the evidence for and against anticoagulation in patients with AHREs.

Main Results:

• Patients with device-detected AHREs have a significantly higher risk of stroke and MACE, including heart failure and myocardial infarction.
• The risk of adverse events is often dependent on the burden of AHREs.
• Current guidelines and evidence for anticoagulation in AHREs are still developing.

Conclusions:

• Atrial high rate episodes are a significant clinical entity requiring further research and defined management strategies.
• The elevated risk of stroke in patients with AHREs suggests a potential need for anticoagulation, but the risk-benefit profile requires careful consideration.
• Further studies are crucial to establish optimal treatment paradigms for patients with device-detected AHREs to mitigate thromboembolic and cardiovascular risks.