Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions

Overview

Journal Rev Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Sep 4

PMID 39228483

Authors

Carola Griffith Brookles

Roberto De Ponti

Vincenzo Russo

Matteo Ziacchi

Gemma Pelargonio

Michela Casella

Maurelio Lauretti

Manola Vilotta

Sakis Themistoclakis

Antonio DOnofrio

Giuseppe Boriani

Matteo Anselmino

Affiliations

Soon will be listed here.

Abstract

Atrial high-rate episodes (AHREs) and subclinical atrial fibrillation (AF) are frequently registered in asymptomatic patients with cardiac implantable electronic devices (CIEDs) and insertable cardiac monitors (ICMs). While an increased risk of thromboembolic events (e.g., stroke) and benefits from anticoagulation have been widely assessed in the setting of clinical AF, concerns persist about optimal clinical management of subclinical AF/AHREs. As a matter of fact, an optimal threshold of subclinical episodes' duration to predict stroke risk is still lacking and recently published randomized clinical trials assessing the impact of anticoagulation on thromboembolic events in this specific setting have shown contrasting results. The aim of this review is to summarize current evidence regarding classification and clinical impact of subclinical AF/AHREs and to discuss the latest evidence regarding the potential benefit of anticoagulation in this setting, highlighting which clinical questions are still unanswered.

Citing Articles

Editorial: Insights in cardiac rhythmology 2023.

Griffith Brookles C, Ruffini S, Anselmino M Front Cardiovasc Med. 2025; 12:1542308.

PMID: 39898108 PMC: 11782236. DOI: 10.3389/fcvm.2025.1542308.

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