HRS Congress 2026 — Prof Ulrich Schotten (Maastricht University, Maastricht, NL) joins us to discuss new findings from the NOAH-AFNET 6 trial examining the distribution of atrial fibrillation burden, its relationship to clinical outcomes, and the effectiveness and safety of anticoagulation based on device reports.

NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) is a landmark randomised trial enrolling patients with device-detected AF — atrial high-rate episodes (AHREs) of ≥6 minutes detected by implanted devices including pacemakers, ICDs, and cardiac resynchronisation therapy systems — in the absence of ECG-documented AF. This presentation examines how AF burden varies across the trial population, how episode duration and cumulative burden relate to downstream stroke risk and cardiovascular outcomes, and what these device-based data reveal about the effectiveness and safety of anticoagulation in this frequently encountered but clinically challenging group.

Interview Questions

1. Device-detected AF and atrial high-rate episodes are increasingly common findings in clinical practice — how do we currently think about their relationship to stroke risk, and why does AF burden matter?
2. What were the specific aims of this analysis from NOAH-AFNET 6, and what made the trial's device-reported data well-suited to address this question?
3. How is AF burden distributed across the NOAH-AFNET 6 population, and what patterns emerge when you look at the relationship between episode duration, cumulative burden, and clinical outcomes?
4. What do the data tell us about the effectiveness and safety of anticoagulation across different burden profiles — are there patient subgroups in whom the benefit-risk balance looks more or less favourable?
5. How do these findings sit alongside the broader NOAH-AFNET 6 results and the complementary evidence from ARTESiA — where is the field converging, and where does uncertainty remain?
6. What are the practical implications for clinicians encountering device reports of AHREs in their patients — what should guide decision-making on anticoagulation today?
7. What are the key research priorities going forward, particularly around defining clinically meaningful burden thresholds and improving patient selection for anticoagulation?

Recorded on-site at HRS Congress 2026, Chicago.
Editors: Jordan Rance, Mirjam Boros
Videographer: Oliver Miles
Support: This is an independent interview produced by Radcliffe Cardiology.