Can Implantable Cardiac Devices Be Used to Lower Risk of Stroke?

Purpose of Review: Implantable cardiac devices provide continuous heart rhythm monitoring. Device-detected atrial high rate episodes (AHREs) are commonly encountered; however, there is no consensus on how this information is best applied to prevention of stroke. This article provides an overview of the current literature on AHREs, stroke prevention, and evolving areas of investigation. Recent Findings: AHREs predict increased thromboembolic risk at durations of 24 h or less. Shorter cutoffs have been less consistently associated with risk. Summary: There is clinical equipoise for the use of oral anticoagulation for device-detected subclinical atrial fibrillation alone. Very short episodes may not require action beyond continued monitoring. Studies are ongoing to address the use of oral anticoagulation for device-detected subclinical AHREs alone, as well as tailored anticoagulation in response to AHREs in those with known history of AF.