Management of atrial high-rate episodes detected by cardiac implanted electronic devices

Research output: Contribution to journalReview articlepeer-review

Standard

Management of atrial high-rate episodes detected by cardiac implanted electronic devices. / Freedman, Ben; Boriani, Giuseppe; Glotzer, Taya V.; Healey, Jeff S.; Kirchhof, Paulus; Potpara, Tatjana S.

In: Nature Reviews Cardiology, Vol. 14, No. 12, 06.07.2017, p. 701-714.

Research output: Contribution to journalReview articlepeer-review

Harvard

APA

Vancouver

Author

Freedman, Ben ; Boriani, Giuseppe ; Glotzer, Taya V. ; Healey, Jeff S. ; Kirchhof, Paulus ; Potpara, Tatjana S. / Management of atrial high-rate episodes detected by cardiac implanted electronic devices. In: Nature Reviews Cardiology. 2017 ; Vol. 14, No. 12. pp. 701-714.

Bibtex

@article{814cf9f88c6547bba191db07ff01d1db,
title = "Management of atrial high-rate episodes detected by cardiac implanted electronic devices",
abstract = "Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF. In addition, a close temporal relationship between AHREs and stroke is seen in only 15% of strokes in patients with a CIED: the majority have either no AHREs before the stroke, or AHREs very distant from incident stroke, suggesting that AHREs might be more of a risk marker than a risk factor for stroke. Management of AHREs should not be the same as for clinical AF, and a degree of uncertainty underpins the rationale for much-needed, ongoing, randomized trials of oral anticoagulation in patients with CIED-detected AHREs. We propose a management algorithm that takes into account both the stroke risk and the AHRE burden, but highlights the current uncertainty and evidence gaps for this condition.",
author = "Ben Freedman and Giuseppe Boriani and Glotzer, {Taya V.} and Healey, {Jeff S.} and Paulus Kirchhof and Potpara, {Tatjana S.}",
year = "2017",
month = jul,
day = "6",
doi = "10.1038/nrcardio.2017.94",
language = "English",
volume = "14",
pages = "701--714",
journal = "Nature Reviews Cardiology",
issn = "1759-5002",
publisher = "Nature Publishing Group",
number = "12",

}

RIS

TY - JOUR

T1 - Management of atrial high-rate episodes detected by cardiac implanted electronic devices

AU - Freedman, Ben

AU - Boriani, Giuseppe

AU - Glotzer, Taya V.

AU - Healey, Jeff S.

AU - Kirchhof, Paulus

AU - Potpara, Tatjana S.

PY - 2017/7/6

Y1 - 2017/7/6

N2 - Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF. In addition, a close temporal relationship between AHREs and stroke is seen in only 15% of strokes in patients with a CIED: the majority have either no AHREs before the stroke, or AHREs very distant from incident stroke, suggesting that AHREs might be more of a risk marker than a risk factor for stroke. Management of AHREs should not be the same as for clinical AF, and a degree of uncertainty underpins the rationale for much-needed, ongoing, randomized trials of oral anticoagulation in patients with CIED-detected AHREs. We propose a management algorithm that takes into account both the stroke risk and the AHRE burden, but highlights the current uncertainty and evidence gaps for this condition.

AB - Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF. In addition, a close temporal relationship between AHREs and stroke is seen in only 15% of strokes in patients with a CIED: the majority have either no AHREs before the stroke, or AHREs very distant from incident stroke, suggesting that AHREs might be more of a risk marker than a risk factor for stroke. Management of AHREs should not be the same as for clinical AF, and a degree of uncertainty underpins the rationale for much-needed, ongoing, randomized trials of oral anticoagulation in patients with CIED-detected AHREs. We propose a management algorithm that takes into account both the stroke risk and the AHRE burden, but highlights the current uncertainty and evidence gaps for this condition.

U2 - 10.1038/nrcardio.2017.94

DO - 10.1038/nrcardio.2017.94

M3 - Review article

C2 - 28682320

VL - 14

SP - 701

EP - 714

JO - Nature Reviews Cardiology

JF - Nature Reviews Cardiology

SN - 1759-5002

IS - 12

ER -