Consideration for ECG recordings (Holter, patient-operated devices) in specific cases (eg, unavailable electrograms or unclear diagnosis at device electrograms analysis) Clinical risk stratification for stroke (CHA2DS2VASc-score)? Clinical cardiological evaluation + 12-lead ECG If diagnosis of AF or atrial flutter and intermediate (CHA2DS2VASc score = 1 in males and = 2 in females) or high risk (CHA2DS2VASc score 2 in males and 3 in females): - Monitoring of AHRE evolution (remote monitoring is advised) - Clinical follow-up for evaluating if AHRE >24 h and/or clinical AF develops, as well as changes in patient status/clinical profile (eg, heart failure) - Individual considerations for prescription of OAC considering overall AHRE burden and AHRE >24 h, individual CHA2DS2VASc, predicted risk benefit of OAC (specifically risk of major bleeding) and patient preferences Clinical decision-making and follow-up Figure 7 Flowchart for clinical management and decision-making in patients with CIEDs-detected AHRE. AHRE atrial high-rate episode; CIED cardiac implanted electrical device. See Figure 1, 3, and 4 legends for expansion of other abbreviations. 1180 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] Atrial Flutter The risk of thromboembolism and stroke in patients with atrial utter has been evaluated in relatively few studies compared with AF. 