Focus issue: Atrial fibrillation: ClinicalDevice: Editorial commentaryAtrial fibrillation and stroke: It's not necessarily all about the rhythm
Section snippets
Device-detected atrial tachycardia (AT)/AF burden and stroke
Timely diagnosis of AF is often challenging because it is frequently asymptomatic.3 Implantable device-based monitoring has been shown to reliably diagnose AF and rapid ATs with superior sensitivity and specificity compared with intermittent external monitoring.4 Although the risk of stroke or systemic emboli (SSE) is comparable in paroxysmal and persistent AF5, the risk of SSE associated with brief AT/AF episodes is less well established.
Evidence emerging from prospective studies suggests that
Etiology of stroke in patients with AF
To date, the available evidence suggests that the majority of AF-related strokes are due to thromboemboli originating from the left atrial appendage.10 Given the absence of a clear temporal relationship between AT/AF episodes in the majority of SSE events, what do the TRENDS data tell us about the mechanisms behind AF-related stroke? First, it is important to note that TRENDS included patients without a prior history of AF. In fact, 20% of the substudy cohort did not have a diagnosis of AF at
Clinical implications
Despite current guideline recommendations that advise against basing stroke prevention treatment decisions on type of AF, clinicians continue to do so.5 Although AT/AF burden does appear to be associated with increased stroke risk, AT/AF arrhythmias will not necessarily or reliably precede and predict SSE. Additionally, attempts to integrate AF burden into risk stratification schemes have improved specificity, but fail to improve sensitivity of more comprehensive measures such as CHA2DS2-VASc.16
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Cited by (8)
Atrial myopathy
2024, Current Problems in CardiologyP-wave indices in Japanese patients with ischemic stroke: Implication of atrial myopathy in subtype of ischemic stroke
2021, Journal of ElectrocardiologyCitation Excerpt :An association of abnormal P-wave indices, hence atrial myopathy, with cardiogenic embolism would be not unexpected finding and the diseased left atrium can be the site of thrombus formation leading to cardioembolic stroke. When atrial myopathy exists, thrombus formation is considered to occur even in the absence of AF [17,29–32]. However, atrial myopathy observed in lacuna stroke patients cannot be the direct cause of small vessel occlusion in the brain.
Atrial Myopathy
2019, JACC: Basic to Translational ScienceCitation Excerpt :Atrial myopathy may manifest periodically as AF but is always present and continually thrombogenic (107). Recent reviews and editorials have suggested the importance of atrial myopathy and have called for additional studies of its role in AF and AF-associated complications (106,108–110). The following section will discuss how to identify patients with atrial myopathy and how to apply the concept of atrial myopathy in guiding OAC therapy in patients with AF.
Mechanical dyssynchrony of the left atrium during sinus rhythm is associated with history of stroke in patients with atrial fibrillation
2018, European Heart Journal Cardiovascular ImagingA Computational Framework for Personalized Blood Flow Analysis in the Human Left Atrium
2016, Annals of Biomedical Engineering
J.P.P. receives research funding from Boston Scientific, Johnson & Johnson, and Bayer Healthcare. J.P.D. received research support from Boston Scientific, St. Jude, Medtronic, Biosense-Webster; institutional fellowship support from Boston Scientific, St. Jude, Medtronic, Biosense-Webster, and Bard; and honoraria for advisory board participation or lectures from Biosense-Webster, Sanofi-Aventis, Boston Scientific, and Sorin Medical.