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Device-detected atrial high-rate episodes and risk of ischemic stroke and progression to atrial fibrillation: A systematic review and meta-analysis
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DOI：10.1177/17474930261472691.png)
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Abstract
En 中文
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>There is a well-established association between atrial fibrillation (AF) and an increased risk of ischemic stroke; new evidence, however, suggests that atrial high-rate episodes (AHREs), a subset of atrial tachycardia (AT), may also contribute to this risk. Through cardiac remodeling pathways and physiological changes, a multi-faceted risk of stroke exists. Our review suggests there is an increased risk of ischemic stroke in the presence of AHREs and, additionally, a greater risk of developing overt AF after these events. There are, however, many inconsistencies within the studies including ambiguity surrounding AHRE definitions and control for anticoagulation and concurrent AF episodes that are not often reported. Further research is warranted to better define atrial high-rate episodes and to further characterize this relationship. While there is clinical direction for anticoagulation in patients with AF, there are no standardized indications for intermediate durations of AHREs and oral anticoagulation is largely determined on an individual basis. Given this gap within clinical practice, we performed a review of the literature to explore if a relationship between episodes of AHREs and ischemic stroke exists, excluding those with a history of prior AF.</jats:p>
</jats:sec>
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<jats:title>Aims:</jats:title>
<jats:p>To systematically review and meta-analyze the association between device-detected AT/AHREs and (1) risk of ischemic stroke and (2) progression to clinical AF, excluding patients with a prior history of AF.</jats:p>
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<jats:title>Summary of review:</jats:title>
<jats:p>
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (PROSPERO CRD42022337209). MEDLINE, EMBASE, and Cochrane databases were searched up to 10 March 2025. Nine studies (n = 5099 patients) met inclusion criteria. Overall, 33.7% experienced at least one AHRE, and 2.5% developed a thromboembolic event during follow-up. A meta-analysis of six studies demonstrated a 2.6-fold increased risk of ischemic stroke in patients with AHREs (pooled hazard ratio (HR) = 2.59, 95% confidence interval (CI) = 1.54–3.64; I
<jats:sup>2</jats:sup>
= 0%). A second meta-analysis demonstrated a 4.5-fold increased risk of progression to AF (pooled effect size = 4.51, 95% CI = 1.50–7.51; I
<jats:sup>2</jats:sup>
= 73.1%). Among the reviewed studies, definitions of AHRE duration and rate varied substantially.
</jats:p>
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<jats:title>Conclusions:</jats:title>
<jats:p>Device-detected AHREs are associated with a significantly increased risk of ischemic stroke and progression to clinical AF in patients without prior AF. While the magnitude of stroke risk is lower than that reported for overt AF, AHREs represent a clinically meaningful risk marker. Standardized definitions and burden thresholds are required to guide anticoagulation strategies and optimize stroke prevention.</jats:p>
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