{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T05:24:41Z","timestamp":1793597081178,"version":"4.5.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Available evidence supports an association between atrial high\u2010rate episode (AHRE) burden and thromboembolic risk, but the necessary extent and duration of AHREs to increase the thromboembolic risk remain to be defined. The aim of this systematic review and meta\u2010analysis was to identify the thromboembolic risk associated with various AHRE thresholds.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We searched PubMed and Scopus until January 9, 2020, for literature reporting AHRE duration and thromboembolic risk in patients with implantable electronic devices. The outcome assessed was stroke or systemic embolism. Risk estimates were reported as hazard ratio (HR) or relative risk alongside 95% CIs. We used the Paule\u2010Mandel estimator, and heterogeneity was calculated with I\n              <jats:sup>2<\/jats:sup>\n              index. Among 27 studies including 61\u00a0919 patients, 23 studies reported rates according to the duration of the longest AHRE and 4 studies reported rates according to the cumulative day\u2010level AHRE duration. In patients with cardiac implantable devices, AHREs lasting \u226530\u00a0seconds significantly increased the risk of stroke or systemic embolism (HR, 4.41; 95% CI, 2.32\u20138.39; I\n              <jats:sup>2<\/jats:sup>\n              , 5.5%), which remained consistent for the thresholds of 5\u00a0minutes and 6 and 24\u00a0hours. Patients with previous stroke or transient ischemic attack and AHREs lasting \u22652\u00a0minutes had a marginally increased risk of recurrent stroke or transient ischemic attack. The risk of stroke or systemic embolism was higher in patients with cumulative AHRE \u226524\u00a0hours compared with those of shorter duration or no AHRE (HR, 1.25; 95% CI, 1.04\u20131.52; I\n              <jats:sup>2<\/jats:sup>\n              , 0%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">This systematic review and meta\u2010analysis suggests that single AHRE episodes \u226530\u00a0seconds and cumulative AHRE duration \u226524\u00a0hours are associated with increased risk of stroke or systemic embolism.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.022487","type":"journal-article","created":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T10:09:46Z","timestamp":1636538986000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Atrial High\u2010Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-5665","authenticated-orcid":false,"given":"Dimitrios","family":"Sagris","sequence":"first","affiliation":[{"name":"Department of Internal Medicine School of Health Sciences Faculty of Medicine University of Thessaly Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7661-5253","authenticated-orcid":false,"given":"Georgios","family":"Georgiopoulos","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences King's College London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Pateras","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Research Support Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Perlepe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine School of Health Sciences Faculty of Medicine University of Thessaly Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Korompoki","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haralampos","family":"Milionis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University Hospital of Ioannina Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Tsiachris","sequence":"additional","affiliation":[{"name":"Athens Heart Center Athens Medical Center Athens Greece"},{"name":"1st Cardiology Department Athens Medical School National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheuk","family":"Chan","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences King's College London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. 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