Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence.
Anticoagulation
Atrial fibrillation
Atrial high-rate episodes
Continuous monitoring
Pacemaker
Stroke
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
01 Oct 2019
01 Oct 2019
Historique:
received:
18
03
2019
accepted:
15
07
2019
pubmed:
5
8
2019
medline:
29
10
2020
entrez:
5
8
2019
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 31377792
pii: 5543496
doi: 10.1093/europace/euz172
pmc: PMC6788209
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1459-1467Subventions
Organisme : British Heart Foundation
ID : FS/13/43/30324
Pays : United Kingdom
Organisme : British Heart Foundation
ID : PG/17/30/32961
Pays : United Kingdom
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Am Heart J. 2017 Aug;190:12-18
pubmed: 28760205
Europace. 2018 Feb 1;20(2):263-270
pubmed: 28069838
Eur Heart J. 2013 Aug;34(31):2464-71
pubmed: 23594592
Eur Heart J. 2013 May;34(20):1471-4
pubmed: 23355653
J Am Heart Assoc. 2013 Jun 21;2(3):e000250
pubmed: 23782923
Heart. 2005 Mar;91(3):362-4
pubmed: 15710720
Eur J Neurol. 2018 Apr;25(4):631-636
pubmed: 29205690
Pacing Clin Electrophysiol. 2007 Mar;30(3):404-11
pubmed: 17367361
Eur Heart J. 2017 May 1;38(17):1339-1344
pubmed: 28329139
JACC Clin Electrophysiol. 2017 Dec 26;3(13):1557-1564
pubmed: 29759838
Circ Arrhythm Electrophysiol. 2010 Apr;3(2):141-7
pubmed: 20160169
J Interv Card Electrophysiol. 2010 Aug;28(2):101-7
pubmed: 20454840
Europace. 2015 Sep;17(9):1449-53
pubmed: 26443791
N Engl J Med. 2019 May 16;380(20):1906-1917
pubmed: 31091372
Lancet Neurol. 2007 Feb;6(2):115-24
pubmed: 17239798
Eur J Neurol. 2016 Feb;23(2):375-81
pubmed: 26470854
J Mol Cell Cardiol. 2015 Jun;83:88-100
pubmed: 25668431
J Am Coll Cardiol. 2018 Jul 10;72(2):141-153
pubmed: 29976287
Lancet. 1989 Jan 28;1(8631):175-9
pubmed: 2563096
Eur Heart J. 2015 Feb 1;36(5):281-7a
pubmed: 25187524
N Engl J Med. 1990 Mar 22;322(12):863-8
pubmed: 2407959
Eur J Neurol. 2014 Jun;21(6):884-9
pubmed: 24628954
J Cardiovasc Electrophysiol. 2002 Jun;13(6):542-7
pubmed: 12108493
J Cardiovasc Electrophysiol. 2016 Dec;27(12):1403-1410
pubmed: 27565119
Am Heart J. 1951 Oct;42(4):566-81
pubmed: 14877750
Circulation. 2016 Oct 18;134(16):1130-1140
pubmed: 27754946
Can J Cardiol. 2013 Feb;29(2):224-8
pubmed: 23142343
Am J Cardiol. 2012 Nov 1;110(9):1309-14
pubmed: 22819433
Circulation. 2017 Oct 3;136(14):1276-1283
pubmed: 28778946
J Cardiovasc Electrophysiol. 2018 May;29(5):707-714
pubmed: 29478291
Circulation. 2014 May 27;129(21):2094-9
pubmed: 24633881
N Engl J Med. 2002 Jun 13;346(24):1854-62
pubmed: 12063369
Circulation. 2015 Jan 13;131(2):157-64
pubmed: 25359164
Neurology. 2007 Aug 7;69(6):546-54
pubmed: 17679673
JAMA Cardiol. 2017 Oct 1;2(10):1120-1127
pubmed: 28842973
J Am Coll Cardiol. 2000 Jan;35(1):183-7
pubmed: 10636278
N Engl J Med. 2018 Oct 4;379(14):1332-1342
pubmed: 30146935
Heart Rhythm. 2014 Dec;11(12):2214-21
pubmed: 25131667
J Am Coll Cardiol. 2007 Nov 27;50(22):2156-61
pubmed: 18036454
N Engl J Med. 2005 Mar 31;352(13):1305-16
pubmed: 15800226
Stroke. 2013 Jul;44(7):2007-9
pubmed: 23674523
Nat Rev Cardiol. 2017 Dec;14(12):701-714
pubmed: 28682320
Heart Rhythm. 2017 Jul;14(7):955-961
pubmed: 28506913
Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):250-5
pubmed: 9474682
N Engl J Med. 1990 Nov 29;323(22):1505-11
pubmed: 2233931
Circ Arrhythm Electrophysiol. 2009 Oct;2(5):474-80
pubmed: 19843914
Europace. 2016 Nov;18(11):1609-1678
pubmed: 27567465
Heart Rhythm. 2012 Aug;9(8):1241-6
pubmed: 22440154
N Engl J Med. 2014 Jun 26;370(26):2478-86
pubmed: 24963567
Eur Heart J Cardiovasc Pharmacother. 2017 Jan;3(1):28-36
pubmed: 27680880
Eur Heart J. 2015 Jul 7;36(26):1660-8
pubmed: 25908774
Eur Heart J. 2017 Mar 21;38(12):907-915
pubmed: 27742807
N Engl J Med. 2013 Nov 28;369(22):2093-104
pubmed: 24251359
J Intern Med. 2008 Jul;264(1):50-61
pubmed: 18266660
Lancet Neurol. 2015 Apr;14(4):361-7
pubmed: 25684164
J Am Coll Cardiol. 2005 Nov 15;46(10):1913-20
pubmed: 16286180
Europace. 2012 Feb;14(2):230-7
pubmed: 21933802
Europace. 2010 Oct;12(10):1360-420
pubmed: 20876603
N Engl J Med. 2012 Jan 12;366(2):120-9
pubmed: 22236222
Ann Intern Med. 1999 Oct 5;131(7):492-501
pubmed: 10507957
Heart Rhythm. 2015 Dec;12(12):2368-75
pubmed: 26164377
Circ J. 2012;76(10):2289-304
pubmed: 23001018
Stroke. 2010 Feb;41(2):256-60
pubmed: 20044517
Stroke. 1991 Aug;22(8):983-8
pubmed: 1866765
Chest. 2010 Feb;137(2):263-72
pubmed: 19762550
N Engl J Med. 2012 May 17;366(20):1859-69
pubmed: 22551105
J Cardiovasc Electrophysiol. 2006 Dec;17(12):1323-8
pubmed: 17081212
Rev Neurol. 2013 Sep 16;57(6):251-7
pubmed: 24008935
Eur Heart J. 2010 Apr;31(8):967-75
pubmed: 19176537
N Engl J Med. 2001 Nov 15;345(20):1444-51
pubmed: 11794192
Circulation. 2003 Apr 1;107(12):1614-9
pubmed: 12668495
N Engl J Med. 2012 Apr 5;366(14):1351; author reply 1352-3
pubmed: 22475607
Eur Heart J. 2016 May 21;37(20):1591-602
pubmed: 26888184
Circulation. 2012 Aug 14;126(7):806-14
pubmed: 22824434
Eur Heart J. 2018 Apr 21;39(16):1407-1415
pubmed: 29340587
Neurology. 2013 Apr 23;80(17):1546-50
pubmed: 23535493
Stroke. 2013 May;44(5):1449-52
pubmed: 23449264
N Engl J Med. 2018 Jun 07;378(23):2191-2201
pubmed: 29766772
Neurology. 1978 Oct;28(10):973-7
pubmed: 570666
Thromb Haemost. 2017 Oct 5;117(10):1962-1969
pubmed: 28862284
Thromb Haemost. 2008 Feb;99(2):295-304
pubmed: 18278178
Am Heart J. 2017 Jul;189:137-145
pubmed: 28625370
Circ Arrhythm Electrophysiol. 2016 Jan;9(1):e003333
pubmed: 26763225
Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1040-7
pubmed: 26175528
Lancet. 2014 Mar 15;383(9921):955-62
pubmed: 24315724
JAMA. 2001 Jun 13;285(22):2864-70
pubmed: 11401607
Europace. 2017 Sep 1;19(9):1556-1578
pubmed: 28934408
JAMA. 2003 Aug 27;290(8):1049-56
pubmed: 12941677
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
pubmed: 24685669
Am J Cardiol. 2008 Aug 15;102(4):450-3
pubmed: 18678304
Europace. 2017 Feb 1;19(2):169-179
pubmed: 28172715