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

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.

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Copyright: © 2024 The Author(s). Published by IMR Press.

Déclaration de conflit d'intérêts

The author declares no conflict of interest. Roberto De Ponti, Vincenzo Russo and Matteo Anselmino are serving as one of the Guest editors of this journal. Giuseppe Boriani is serving as Editor-in-Chief of this journal. We declare that Roberto De Ponti, Vincenzo Russo, Matteo Anselmino and Giuseppe Boriani had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Bernard Belhassen. MA is consultant for Johnson & Johnson and Boston Scientific, clinical proctor for Medtronic, and has received educational grants from Abbott; RDP has received honoraria for lecture and scientific collaboration from Biosense Webster and Medtronic; MZ received speaker’s fees from Abbott and Boston Scientific, Biotronik; MC received speaker’s fees from Abbott and Biosense Webster; GB reported speaker’s fees of small amount from Bayer, Boston, Boehringer, Daiichi-Sankyo, Janssen, Sanofi outside the submitted work. None of the above-mentioned conflicts relates to the topic of this manuscript.