Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?

Abstract

Atrial high rate episodes (AHREs), also termed, subclinical atrial tachyarrhythmias or subclinical atrial fibrillation (AF) are an important cardiovascular condition. Advancement in implantable cardiac devices such as pacemakers or internal cardiac defibrillators has enabled the continuous assessment of atrial tachyarrhythmias in patients with an atrial lead. Patients with device-detected AHREs are at an elevated risk of stroke and may have unmet anticoagulation needs. While the benefits of oral anticoagulation for stroke prevention in patients with clinical AF are well recognised, it is not known whether the same risk-benefit ratio exists for anticoagulation therapy in patients with AHREs. The occurrence and significance of AHRE are increasingly acknowledged but these events are still not often acted upon in patients presenting with stroke and TIA. Additionally, patients with AHRE show a significant risk for major adverse cardiovascular events (MACE) including acute heart failure, myocardial infarction, cardiovascular hospitalisation, ventricular tachycardia/fibrillation, which is dependent on AHRE burden. In this review, we present an overview of this relatively new entity, its associated thromboembolic risk and its management implications.

Atrial inflammation in different atrial fibrillation subtypes and its relation with clinical risk factors

“…Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia [ 1 ], and is associated with an increased risk of stroke, heart failure, and death [ 2 – 4 ]. Estimates on the incidence of AF (diagnosed and undiagnosed) in the general adult population ranged from 0.95 to 2.5% [ 5 ].…”

Remote monitoring and telemedicine in heart failure: implementation and benefits

“…These episodes, common in patients necessitating CIEDs, include different forms of atrial tachyarrhythmias such as atrial tachycardias, atrial flutter and AF [28]. AHREs are associated with a considerable risk of adverse clinical events including death [29], hospitalizations [30,31], stroke/systemic thromboembolism [32][33][34], occurrence of heart failure [35], and progression to clinical AF [36]. In 2012, 2580 patients with no history of AF were enrolled in the prospective ASSERT [32] trial and were followed for a mean of 2.5 years.…”

Update on Biomarkers Associated to Cardioembolic Stroke: A Narrative Review

“…The actual prevalence of atrial cardiomyopathy is unknown but the extensive list of associated predisposing factors, such as aging, high blood pressure, obesity, diabetes mellitus, and obstructive sleep apnea, suggest that this is a frequently encountered and important clinical condition [ 47 , 48 ]. Furthermore, there is growing evidence that supports the role of atrial cardiomyopathy as an independent determinant of stroke risk, particularly of embolic stroke subtypes [ 47 , 49 , 50 , 51 ].Several biomarkers of left atrial dysfunction have been proposed for the diagnosis of atrial cardiopathy, with most of the literature referring to left atrial size (left atrial enlargement), P wave dispersion, P-wave terminal force in lead V1 on EKG, paroxysmal supraventricular tachycardia, atrial high rate episodes, atrial fibrosis, and elevation of serum biomarkers associated with atrial dysfunction like NT-proBNP [ 52 , 53 , 54 ]. However, it should be noted that some of these biomarkers are not specific to atrial dysfunction [ 52 ].…”