Atrial high-rate episodes (AHRE) are short and rare atrial arrhythmias that resemble atrial fibrillation detected by implanted pacemakers, defibrillators, and loop recorders that enable long-term monitoring of heart rhythm. AHRE are found in 10–30% of patients with implanted devices. AHRE episodes resemble atrial fibrillation. Therefore, patients with AHRE are often offered treatment with blood thinners (oral anticoagulation) without ECG-documented atrial fibrillation. So far, the efficacy and safety of oral anticoagulation has never been tested in patients with AHRE.
The Non vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes trial compared the anticoagulant edoxaban to placebo in an international investigator-initiated, randomized, double-blind, double-dummy outcomes trial.
Between 2016 and 2022, NOAH—AFNET 6 enrolled 2,536 patients in 206 sites across 18 European countries. Patients were randomly allocated in a 1:1 fashion to anticoagulation or no anticoagulation. The analysis included the data of 2,536 patients aged 78 on average; 37% were women. The patients had additional stroke risk factors and a median AHRE duration of 2.8 hours. All patients were followed until the end of the trial.
Stroke, systemic embolism, or cardiovascular death occurred in 83 patients in the anticoagulation group and 101 patients in the no anticoagulation group . This means no significant difference between treatment groups .
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