Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias detected by continuous rhythm monitoring by pacemakers, defibrillators, or implantable cardiac monitors. Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation. However, it remains unclear whether the presence of these arrhythmias has therapeutic consequences. The presence of AHRE increases the risk of stroke compared with patients without AHRE. Oral anticoagulation would have the potential to reduce the risk of stroke in patients with AHRE but is also associated with a rate of major bleeding of ∼2%/year. The stroke rate in patients with AHRE appears to be lower than the stroke rate in patients with atrial fibrillation. Wearables like smart-watches will increase the absolute number of patients in whom atrial arrhythmias are detected. It remains unclear whether anticoagulation is effective and, equally important, safe in patients with AHRE. Two randomized clinical trials, NOAH-AFNET6 and ARTESiA, are expected to report soon. They will provide much-needed information on the efficacy and safety of oral anticoagulation in patients with AHRE.

Arrhythmias Unit of Cardiology Department Hospital Prof Dr Fernando Fonseca 2720 276 Amadora Sintra Portugal

Atrial Fibrillation NETwork 48149 Muenster Germany

Cardiac Department John Radcliffe Hospital Oxford OX3 9DU UK

Cardiac Electrophysiology Section European Georges Pompidou Hospital 75015 Paris France

Cardiology Clinic St Anna University Hospital Medical University Sofia 1750 Sofia Bulgaria

Cardiovascular Clinical Institute Hospital Clinic Universitat de Barcelona 08036 Barcelona Catalonia Spain

Department 5 Colentina University Hospital Medicine University 'Carol Davila' Bucharest 020021 Romania

Department of Cardiac Vascular Thoracic and Public Health Sciences Azienda Ospedaliera 35128 Padua Italy

Department of Cardiology and Internal Diseases Medical University of Gdańsk 80 210 Gdańsk Poland

Department of Cardiology Heart Center Amsterdam University Medical Center University of Amsterdam 1081 HV Amsterdam The Netherlands

Department of Cardiology Institute for Clinical and Experimental Medicine 140 21 Prague 4 Czech Republic

Department of Cardiology Odense University Hospital 5230 Odense Denmark

Department of Cardiology University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Martinistr 52 Hamburg 20246 Germany

Department of Clinical Research University of Southern Denmark 5230 Odense Denmark

Department of Medical Science Uppsala University 751 85 Uppsala Sweden

Faculty of Medicine and Health Department of Cardiology School of Medical Sciences Örebro University 701 85 Örebro Sweden

German Center for Cardiovascular Research Partner Site Hamburg Kiel Luebeck Martinistr 52 20246 Hamburg Germany

Heart and Vascular Center Semmelweis University Budapest 1122 Budapest Hungary

Institute of Cardiovascular Sciences University of Birmingham UHB and Sandwell and West Birmingham Hospitals NHS Trusts IBR 126a Wolfson Drive Birmingham B15 2TT UK

University Hospital of Internal Medicine 3 Medical University Innsbruck 6020 Innsbruck Austria

Ventricular Arrhythmia and Sudden Death Management Unit Heart Rhythm Management Center University Hospital of Brussels 1090 Brussels Belgium

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Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h