Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence

Research output: Contribution to journalReview articlepeer-review


  • Emanuele Bertaglia
  • Benjamin Blank
  • Carina Blomström-Lundqvist
  • Axel Brandes
  • Nuno Cabanelas
  • G-Andrei Dan
  • Wolfgang Dichtl
  • Andreas Goette
  • Joris R de Groot
  • Andrzej Lubinski
  • Eloi Marijon
  • Béla Merkely
  • Lluis Mont
  • Christopher Piorkowski
  • Andrea Sarkozy
  • Neil Sulke
  • Panos Vardas
  • Vasil Velchev
  • Dan Wichterle

Colleges, School and Institutes

External organisations

  • Department of Cardiac, Vascular and Thoracic Sciences, Azienda Ospedaliera, Padua, Italy.
  • Atrial Fibrillation NETwork (AFNET), Muenster, Germany.
  • University of Uppsala
  • Department of Cardiology, Odense University Hospital, Odense, Denmark.
  • Arrhythmias Unit of Cardiology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora-Sintra, Portugal.
  • Colentina University Hospital, Medicine University "Carol Davila"
  • University Hospital of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
  • Chief of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Paderborn, Germany.
  • University of Amsterdam
  • Department of Interventional Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland.
  • Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France.
  • Semmelweis University
  • Universitat de Barcelona
  • Herzzentrum Dresden GmbH, Universitätsklinikum, Dresden, Germany.
  • Universitair Ziekenhuis Antwerpen, Edegem, Belgium.
  • Eastbourne District General Hospital, Eastbourne, UK.
  • Heart Sector, Hygeia Group Hospitals, Athens, Greece.
  • Cardiology Clinic, St. Anna University Hospital, Medical University Sofia, Sofia, Bulgaria.
  • Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
  • Sandwell and West Birmingham Hospitals NHS Trust


Self-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10-30% of AF-free patients. Presence of AHRE slightly increases stroke risk (0.8% to 1%/year) compared with patients without AHRE. Atrial high-rate episode of longer duration (e.g. those >24 h) could be associated with a higher stroke risk. Oral anticoagulation has the potential to reduce stroke risk in patients with AHRE but is associated with a rate of major bleeding of 2%/year. Oral anticoagulation is not effective in patients with heart failure or survivors of a stroke without AF. It remains unclear whether anticoagulation is effective and safe in patients with AHRE. Atrial high-rate episodes are common and confer a slight increase in stroke risk. There is true equipoise on the best way to reduce stroke risk in patients with AHRE. Two ongoing trials (NOAH-AFNET 6 and ARTESiA) will provide much-needed information on the effectiveness and safety of oral anticoagulation using non-vitamin K antagonist oral anticoagulants in patients with AHRE.

Bibliographic note

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (


Original languageEnglish
Number of pages9
Publication statusPublished - 3 Aug 2019


  • Atrial fibrillation, Atrial high-rate episodes, Pacemaker, Stroke, Anticoagulation, Continuous monitoring