Atrial high-rate episodes and stroke prevention.
While the benefit of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) is well established, it is not known whether oral anticoagulation is indicated in patients with atrial high-rate episodes (AHRE) recorded on a cardiac implantable electronic device, sometimes also called subclinical AF, and lasting for at least 6 min in the absence of clinically diagnosed AF. Clinical evidence has shown that short episodes of rapid atrial tachycarrhythmias are often detected in patients presenting with stroke and transient ischaemic attack. Patients with AHRE have a higher likelihood of suffering from subsequent strokes, but their stroke rate seems lower than in patients with diagnosed AF, and not all AHRE episodes correspond to AF. The prognostic and pathological significance of AHRE is not yet fully understood. Clinical trials of OAC therapy are being conducted to determine whether therapeutic intervention would be beneficial to patients experiencing AHRE in terms of reducing the risk of stroke.
Department of Clinical Cardiology, St George's University of London, London, UK.
A John
AJ
Camm
Cardiology Department, Heraklion University Hospital, Voutes, Heraklion, Crete, Greece.
Emmanuel
E
Simantirakis
Chief of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Paderborn, Germany.
Andreas
A
Goette
University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GY
Lip
Cardiology Department, Heraklion University Hospital, Voutes, Heraklion, Crete, Greece.
Panos
P
Vardas
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Melanie
M
Calvert
Biostatistics Lab, School of Medicine, University of Crete, Crete, Greece.
Gregory
G
Chlouverakis
Department of Neurology, University Hospital Essen, Essen, Germany.
Hans-Christoph
HC
Diener
Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK|Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
Paulus
P
Kirchhof
D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants
Atrial fibrillation; Stroke; Thromboembolic risk; Atrial high-rate episodes; Subclinical atrial fibrillation; Paroxysmal atrial fibrillation; Anticoagulation; Cardiovascular implantable electronic devices