Atrial High Rate Episodes (AHRE) – what are they and how should we approach them?

18/03/23

Take Home Messages
AHRE are common asymptomatic atrial tachyarrhythmias detected by an implanted cardiac device. Patients with AHRE > 6 mins are 3 – 4 times more likely to develop clinical AF: consider it a marker of atrial myopathy and tackle cardiovascular risk factors early, especially hypertension. Increasing burden of AHRE is associated with increased thromboembolism and episodes 3 24h should be considered for anticoagulation in high-risk patients. Two new RCTs (ARTESIA and NOAH-AFNET 6) agree that anticoagulation for AHRE 6 min – 24h reduces ischaemic stroke risk (RR 0.68), but at the expense of increased major bleeding (RR 1.62).

Take Home Messages

AHRE are common asymptomatic atrial tachyarrhythmias detected by an implanted cardiac device.
Patients with AHRE > 6 mins are 3 – 4 times more likely to develop clinical AF: consider it a marker of atrial myopathy and tackle cardiovascular risk factors early, especially hypertension.
Increasing burden of AHRE is associated with increased thromboembolism and episodes 3 24h should be considered for anticoagulation in high-risk patients.
Two new RCTs (ARTESIA and NOAH-AFNET 6) agree that anticoagulation for AHRE 6 min – 24h reduces ischaemic stroke risk (RR 0.68), but at the expense of increased major bleeding (RR 1.62).

Introduction

Atrial High Rate Episodes (AHRE) are asymptomatic flurries of increased atrial rates detected by a cardiac implanted electronic device (CIED) in patients without history of clinical atrial fibrillation (AF). They are common, detected in around a third of hypertensive over 65-year-olds within the first 2.5 years of pacemaker implant (1). Their clinical significance is unclear. Should AHRE be seen as a precursor to AF? Do they contribute to thromboembolic risk? And if so, should we offer anticoagulation to these patients even in the absence of surface ECG confirmation of AF?

Atrial High Rate Episodes (AHRE) – what are they and how should we approach them?

Introduction

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