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

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Atrial high-rate episodes : prevalence, stroke risk, implications for management, and clinical gaps in evidence. / Bertaglia, Emanuele; Blank, Benjamin; Blomström-Lundqvist, Carina; Brandes, Axel; Cabanelas, Nuno; Dan, G-Andrei; Dichtl, Wolfgang; Goette, Andreas; de Groot, Joris R; Lubinski, Andrzej; Marijon, Eloi; Merkely, Béla; Mont, Lluis; Piorkowski, Christopher; Sarkozy, Andrea; Sulke, Neil; Vardas, Panos; Velchev, Vasil; Wichterle, Dan; Kirchhof, Paulus.

In: Europace, 03.08.2019.

Research output: Contribution to journalReview articlepeer-review

Harvard

Bertaglia, E, Blank, B, Blomström-Lundqvist, C, Brandes, A, Cabanelas, N, Dan, G-A, Dichtl, W, Goette, A, de Groot, JR, Lubinski, A, Marijon, E, Merkely, B, Mont, L, Piorkowski, C, Sarkozy, A, Sulke, N, Vardas, P, Velchev, V, Wichterle, D & Kirchhof, P 2019, 'Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence', Europace. https://doi.org/10.1093/europace/euz172

APA

Bertaglia, E., Blank, B., Blomström-Lundqvist, C., Brandes, A., Cabanelas, N., Dan, G-A., Dichtl, W., Goette, A., de Groot, J. R., Lubinski, A., Marijon, E., Merkely, B., Mont, L., Piorkowski, C., Sarkozy, A., Sulke, N., Vardas, P., Velchev, V., Wichterle, D., & Kirchhof, P. (2019). Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence. Europace. https://doi.org/10.1093/europace/euz172

Vancouver

Author

Bertaglia, Emanuele ; Blank, Benjamin ; Blomström-Lundqvist, Carina ; Brandes, Axel ; Cabanelas, Nuno ; Dan, G-Andrei ; Dichtl, Wolfgang ; Goette, Andreas ; de Groot, Joris R ; Lubinski, Andrzej ; Marijon, Eloi ; Merkely, Béla ; Mont, Lluis ; Piorkowski, Christopher ; Sarkozy, Andrea ; Sulke, Neil ; Vardas, Panos ; Velchev, Vasil ; Wichterle, Dan ; Kirchhof, Paulus. / Atrial high-rate episodes : prevalence, stroke risk, implications for management, and clinical gaps in evidence. In: Europace. 2019.

Bibtex

@article{8df5ed8c6a3a4db38bb85df09d3c1a39,
title = "Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence",
abstract = "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.",
keywords = "Atrial fibrillation, Atrial high-rate episodes, Pacemaker, Stroke, Anticoagulation, Continuous monitoring",
author = "Emanuele Bertaglia and Benjamin Blank and Carina Blomstr{\"o}m-Lundqvist and Axel Brandes and Nuno Cabanelas and G-Andrei Dan and Wolfgang Dichtl and Andreas Goette and {de Groot}, {Joris R} and Andrzej Lubinski and Eloi Marijon and B{\'e}la Merkely and Lluis Mont and Christopher Piorkowski and Andrea Sarkozy and Neil Sulke and Panos Vardas and Vasil Velchev and Dan Wichterle and Paulus Kirchhof",
note = "{\textcopyright} 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 (http://creativecommons.org/licenses/by-nc/4.0/)",
year = "2019",
month = aug,
day = "3",
doi = "10.1093/europace/euz172",
language = "English",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",

}

RIS

TY - JOUR

T1 - Atrial high-rate episodes

T2 - prevalence, stroke risk, implications for management, and clinical gaps in evidence

AU - Bertaglia, Emanuele

AU - Blank, Benjamin

AU - Blomström-Lundqvist, Carina

AU - Brandes, Axel

AU - Cabanelas, Nuno

AU - Dan, G-Andrei

AU - Dichtl, Wolfgang

AU - Goette, Andreas

AU - de Groot, Joris R

AU - Lubinski, Andrzej

AU - Marijon, Eloi

AU - Merkely, Béla

AU - Mont, Lluis

AU - Piorkowski, Christopher

AU - Sarkozy, Andrea

AU - Sulke, Neil

AU - Vardas, Panos

AU - Velchev, Vasil

AU - Wichterle, Dan

AU - Kirchhof, Paulus

N1 - © 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 (http://creativecommons.org/licenses/by-nc/4.0/)

PY - 2019/8/3

Y1 - 2019/8/3

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Atrial high-rate episodes

KW - Pacemaker

KW - Stroke

KW - Anticoagulation

KW - Continuous monitoring

U2 - 10.1093/europace/euz172

DO - 10.1093/europace/euz172

M3 - Review article

C2 - 31377792

JO - Europace

JF - Europace

SN - 1099-5129

ER -