Atrial high rate episodes in patients with dual-chamber cardiac implantable electronic devices: unmasking silent atrial fibrillation.

Assessment of the prevalence of silent paroxysmal atrial fibrillation (AF) represents a challenge, since the arrhythmia may be brief, completely asymptomatic, and difficult to detect. Lack of symptoms from AF should not be equated to lack of risk of thromboembolic complications. Today's cardiac implantable electronic devices (CIED) diagnostics include system diagnostics accurately revealing asymptomatic cardiac arrhythmias as atrial high rate episodes (AHRE). The presence of AHRE has been related to increased risk of stroke and systemic embolism. The application of anticoagulation therapy in patients with device-detected AHRE is yet unclear and challenging in the absence of randomized studies. Until further studies are available, anticoagulation therapy should be individualized and promoted attending to the CHADS2 score. Future guidelines should deal with this peculiar AF scenario to make professionals who routinely perform CIED follow-ups aware of these relevant episodes and their clinical implications.