Letter to the Editor| Volume 93, P115-116, November 2021

Atrial high rate episodes as a marker of atrial cardiomyopathy: In the quest of the Holy Grail

Published:August 17, 2021DOI:
      Cardiac Implantable Electronic Devices (CIEDs) with atrial lead implanted allow detection of asymptomatic atrial tachy-arrhythmias defined as Atrial High Rate Episodes (AHRE) which are found in approximately 20% of CIED patients. Two recent meta-analyses showed that AHRE are associated with an increased risk of stroke (approximately 2-fold) and clinically overt Atrial Fibrillation (AF) (approximately 4-fold) in subjects with no previous history of clinical AF.


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        • Doundoulakis I.
        • Gavriilaki M.
        • Tsiachris D.
        • Arsenos P.
        • Antoniou C.K.
        • Dimou S.
        • et al.
        Atrial high-rate episodes in patients with devices without a history of atrial fibrillation: a systematic review and meta-analysis.
        Cardiovasc Drugs Ther. 2021;
        • Vitolo M.
        • Imberti J.F.
        • Maisano A.
        • Albini A.
        • Bonini N.
        • Valenti A.C.
        • et al.
        Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis.
        Eur J Internal Med. 2021;
        • Brambatti M.
        • Connolly S.J.
        • Gold M.R.
        • Morillo C.A.
        • Capucci A.
        • Muto C.
        • et al.
        Temporal relationship between subclinical atrial fibrillation and embolic events.
        Circulation. 2014; 129: 2094-2099
        • Li Y.G.
        • Miyazawa K.
        • Pastori D.
        • Szekely O.
        • Shahid F.
        • Lip G.Y.H.
        Atrial high-rate episodes and thromboembolism in patients without atrial fibrillation: the West Birmingham Atrial Fibrillation Project.
        Int J Cardiol. 2019; 292: 126-130
        • Haft J.I.
        Letter by haft regarding article, ``temporal relationship between subclinical atrial fibrillation and embolic events".
        Circulation. 2015; 131 (e336-e)
        • Di Biase L.
        • Santangeli P.
        • Anselmino M.
        • Mohanty P.
        • Salvetti I.
        • Gili S.
        • et al.
        Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study.
        J Am Coll Cardiol. 2012; 60: 531-538
        • King J.B.
        • Azadani P.N.
        • Suksaranjit P.
        • Bress A.P.
        • Witt D.M.
        • Han F.T.
        • et al.
        Left Atrial fibrosis and risk of cerebrovascular and cardiovascular events in patients with atrial fibrillation.
        J Am Coll Cardiol. 2017; 70: 1311-1321
        • He J.
        • Tse G.
        • Korantzopoulos P.
        • Letsas K.P.
        • Ali-Hasan-Al-Saegh S.
        • Kamel H.
        • et al.
        P-wave indices and risk of ischemic stroke: a systematic review and meta-analysis.
        Stroke. 2017; 48: 2066-2072
        • Witt C.T.
        • Kronborg M.B.
        • Sommer A.
        • Hansen P.B.
        • Nohr E.A.
        • Nørgaard B.L.
        • et al.
        Left atrial function determined by cardiac computed tomography predicts device-detected atrial high-rate episodes in patients treated with cardiac resynchronization therapy.
        J Comput Assist Tomogr. 2020; 44: 784-789
        • Kirchhof P.
        • Blank B.F.
        • Calvert M.
        • Camm A.J.
        • Chlouverakis G.
        • Diener H.C.
        • et al.
        Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.
        Am Heart J. 2017; 190: 12-18
        • Lopes R.D.
        • Alings M.
        • Connolly S.J.
        • Beresh H.
        • Granger C.B.
        • Mazuecos J.B.
        • et al.
        Rationale and design of the apixaban for the reduction of thrombo-embolism in patients with device-detected sub-clinical atrial fibrillation (ARTESiA) trial.
        Am Heart J. 2017; 189: 137-145
        • Siddiqi T.J.
        • Usman M.S.
        • Shahid I.
        • Ahmed J.
        • Khan S.U.
        • Ya'qoub L.
        • et al.
        Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: a systematic review and meta-analysis.
        Eur J Prev Cardiol. 2021;