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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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http://dx.doi.org/10.31083/j.rcm2508305 | DOI Listing |
BMC Cardiovasc Disord
August 2025
Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.
Objective: Surgical ablation of atrial fibrillation (AF) is suitable for patients with AF undergoing concomitant cardiac surgery. However, the high rate of AF recurrence after surgery remains a significant clinical concern. This study examined the association between insulin resistance (IR) indices and late AF recurrence in patients undergoing modified maze surgery combined with valvular heart surgery.
View Article and Find Full Text PDFJ Clin Med
July 2025
Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Subclinical atrial fibrillation (SCAF) episodes are frequently detected in patients with cardiac implantable electronic devices (CIEDs). These asymptomatic arrhythmias are increasingly recognized as potential harbingers of clinical atrial fibrillation and thromboembolic events. However, the management of SCAF-particularly regarding the use of oral anticoagulation (OAC)-remains controversial.
View Article and Find Full Text PDFCureus
June 2025
Surgery, Dominican Institute of Cardiology Association, Santo Domingo, DOM.
Introduction Atrial high-rate episodes (AHREs) detected by dual-chamber pacemakers may represent subclinical precursors of atrial fibrillation and thromboembolic events. However, the clinical-, electrocardiographic-, and device-related characteristics distinguishing patients with and without AHREs are not fully defined. This study aimed to compare these variables between both groups to identify those independently associated with the presence of AHREs.
View Article and Find Full Text PDFJ Physiol
July 2025
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht University Medical Center, Maastricht, The Netherlands.
Small-conductance calcium-activated potassium (SK) channels are promising targets for atrial-specific antiarrhythmic therapies, with evidence suggesting tachycardia-dependent SK-channel upregulation. However, the dynamics of SK-channel gating and trafficking in human atrial electrophysiology remain unclear because of experimental limitations, including the availability of human cardiomyocytes and long patch clamp experiments. Although computational models help explore these mechanisms, none integrate SK-channel trafficking.
View Article and Find Full Text PDFBMC Cardiovasc Disord
July 2025
Department of Cardiology, the First Affiliated Hospital of Soochow University, No. 188, Shizi Road, Suzhou, 215006, China.
Background: The study is aimed at identifying the risk factors for long-standing atrial high rate episodes(AHREs) following pacemaker implantation.
Methods: A retrospective study was conducted on 180 patients who underwent pacemaker implantation between 01 Jan 2021 and 31 Dec 2021. Patients were divided into AHRE group(70 cases) and no AHRE group(110 cases) based on pacemaker interrogation results.