Conclusion Patients with an AHRE burden over 6 min have an increased risk for stroke .
Aims Atrial fibrillation ( AF ) patients have increased risk of stroke .
In paroxysmal AF , the combination of duration and frequency of episodes defines AF burden .
In patients with cardiac implantable electronic devices ( CIEDs ) , atrial high-rate episodes ( AHREs ) can be monitored continuously and are considered as a proxy for AF .
This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events ( TBEs ) .
Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices.
AIMS Atrial tachyarrhythmias ( ATs ) detected by implanted devices are often atrial fibrillation or flutter ( AF ) associated with stroke . We hypothesized that introduction and termination of anticoagulation based upon AT monitoring would reduce both stroke and bleeding . METHODS AND RESULTS We r and omized 2718 patients with dual-chamber and biventricular defibrillators to start and stop anticoagulation based on remote rhythm monitoring vs. usual office-based follow-up with anticoagulation determined by st and ard clinical criteria .  The primary analysis compared the composite endpoint of stroke , systemic embolism , and major bleeding with the two strategies . The trial was stopped after 2 years median follow-up based on futility of finding a difference in primary endpoints between groups . A total of 945 patients ( 34.8 % ) developed AT , 264 meeting study anticoagulation criteria . Adjudicated atrial electrograms confirmed AF in 91 % ; median time to initiate anticoagulation was 3 vs. 54 days in the intervention and control groups , respectively ( P < 0.001 ) . Primary events ( 2.4 vs. 2.3 per 100 patient-years ) did not differ between groups ( HR 1.06 ; 95 % CI 0.75 - 1.51 ; P = 0.732 ) . Major bleeding occurred at 1.6 vs. 1.2 per 100 patient-years ( HR 1.39 ; 95 % CI 0.89 - 2.17 ; P = 0.145 ) . In patients with AT , thromboembolism rates were 1.0 vs. 1.6 per 100 patient-years ( relative risk -35.3 % ; 95 % CI -70.8 to 35.3 % ; P = 0.251 ) . Although AT burden was associated with thromboembolism , there was no temporal relationship between AT and stroke . CONCLUSION In patients with implanted defibrillators , the strategy of early initiation and interruption of anticoagulation based on remotely detected AT did not prevent thromboembolism and bleeding . CLINICAL TRIAL REGISTRATION IMPACT Clinical Trials.gov identifier : NCT00559988 ( http:// clinical trials.gov/ct2/show/NCT00559988?term=NCT00559988&rank=1 )
Conclusion Patients with an AHRE burden over 6 min have an increased risk for stroke .
Aims Atrial fibrillation ( AF ) patients have increased risk of stroke .
In paroxysmal AF , the combination of duration and frequency of episodes defines AF burden .
In patients with cardiac implantable electronic devices ( CIEDs ) , atrial high-rate episodes ( AHREs ) can be monitored continuously and are considered as a proxy for AF .
This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events ( TBEs ) .