Management of Device-detected Atrial High-rate Episodes

Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs) with atrial leads. These atrial tachyarrhythmias are detected as atrial high-rate episodes (AHREs) by the CIED. AHREs may be brief, infrequent, and asymptomatic, and may be detected before clinical arrhythmia is apparent. These subclinical device-detected AHREs are associated with an increased stroke risk, similar to, but to a lesser degree than, clinically apparent atrial fibrillation detected by routine methods. Whether a specific duration of AHREs is needed before the risk of stroke increases and whether treatment with anticoagulation for subclinical device-detected AHREs reduces stroke risk is unclear.