Harnessing the Deluge of Rhythm-Monitoring Data for the Prevention of Stroke

This editorial contextualizes the NOAH-AFNET 6 trial, which evaluated oral anticoagulation with edoxaban in patients aged ≥65 with device-detected atrial high-rate episodes (AHREs) and no ECG-confirmed atrial fibrillation. Despite higher bleeding risks, edoxaban did not significantly reduce cardiovascular death, stroke, or systemic embolism compared to placebo. The editorial underscores how rhythm monitoring via implanted devices captures brief arrhythmias often missed in standard ECGs and discusses whether AHREs alone warrant anticoagulation. Authors highlight the low observed stroke risk (~1%/year), suggest withholding anticoagulants until ECG-confirmed AF develops, and call for nuanced stroke risk stratification in subclinical arrhythmias. The piece situates NOAH-AFNET 6 in broader trials (e.g., LOOP, ARTESIA) and discusses clinical implications for wearable tech and rhythm-guided stroke prevention.

This editorial contextualizes the NOAH-AFNET 6 trial, which evaluated oral anticoagulation with edoxaban in patients aged ≥65 with device-detected atrial high-rate episodes (AHREs) and no ECG-confirmed atrial fibrillation. Despite higher bleeding risks, edoxaban did not significantly reduce cardiovascular death, stroke, or systemic embolism compared to placebo. The editorial underscores how rhythm monitoring via implanted devices captures brief arrhythmias often missed in standard ECGs and discusses whether AHREs alone warrant anticoagulation. Authors highlight the low observed stroke risk (~1%/year), suggest withholding anticoagulants until ECG-confirmed AF develops, and call for nuanced stroke risk stratification in subclinical arrhythmias. The piece situates NOAH-AFNET 6 in broader trials (e.g., LOOP, ARTESIA) and discusses clinical implications for wearable tech and rhythm-guided stroke prevention.