Antithrombotic therapy in patients with atrial high-rate episodes (AHREs): Current evidence and open questions

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Cardiac electronic implantable devices frequently detect asymptomatic atrial arrhythmias like atrial high-rate episodes (AHREs) and subclinical atrial fibrillation (SCAF).
• AHREs are recognized as potential precursors to overt atrial fibrillation (AF) and are associated with increased cardiovascular event risk.

Purpose of the Study:

• To review and synthesize current evidence regarding the clinical implications of AHREs and device-detected SCAF.
• To identify gaps in risk stratification and management strategies for patients with these subclinical arrhythmias.

Main Methods:

• Systematic review of existing literature on AHREs and device-detected SCAF.
• Appraisal of evidence concerning the association with thromboembolic events and cardiovascular outcomes.
• Evaluation of current guidelines and ongoing debates on anticoagulant therapy.

Main Results:

• AHREs and SCAF are associated with an increased risk of thromboembolic events and major cardiovascular events, including myocardial infarction and heart failure.
• Despite these risks, routine anticoagulant therapy is not currently recommended for patients with AHREs or SCAF.
• The relationship between stroke risk and AHREs, and the potential benefit of anticoagulation, remains an area of active research and debate.

Conclusions:

• Patients with AHREs/SCAF face elevated risks for adverse cardiovascular outcomes, necessitating further research into effective risk stratification.
• The clinical management of AHREs/SCAF, particularly the role of anticoagulation, requires further investigation to guide therapeutic decisions.
• Ongoing research is crucial to clarify the prognostic significance and optimal treatment strategies for subclinical atrial arrhythmias.