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[Isolated atrial fibrillation. The risk of embolism and its prevention]
J Fouchard1, F Le, A Py
1Service des Maladies cardiovasculaires, Hôpital Cochin, Paris.
Insights
Determining if atrial fibrillation is idiopathic is challenging. Embolization risk is higher in older adults with dilated left atria, especially with chronic or recent-onset atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
Context:
- Atrial fibrillation (AF) diagnosis and risk stratification.
- Understanding embolization risks in AF patients.
Purpose:
- To assess the risk of embolization in lone atrial fibrillation.
- To evaluate anticoagulant therapy and sinus rhythm restoration as preventative strategies.
Summary:
- Embolization risk in lone atrial fibrillation is elevated in individuals over 60 with a dilated left atrium.
- Chronic AF presents a higher risk than paroxysmal AF, particularly within the first year of onset.
- Anticoagulant therapy is generally effective for preventing embolic events, with aspirin showing similar results in those over 75.
- Restoring sinus rhythm is a viable alternative, even in elderly patients, if AF is recent and the left atrium is moderately dilated.
Impact:
- Informs clinical decisions regarding anticoagulation and rhythm management in atrial fibrillation patients.
- Highlights the importance of left atrial size and AF type in predicting embolic risk.
- Provides evidence for therapeutic strategies in preventing stroke and systemic embolism in AF.
Abstract:
Whether or not atrial fibrillation is alone, if not idiopathic, is difficult to determine. The risk of embolization in lone atrial fibrillation is distinctly higher in healthy subjects over 60 years of age when the left atrium is dilated. In chronic atrial fibrillation this risk is higher than in paroxysmal fibrillation, especially within the year following the onset of the arrhythmia. In most patients anticoagulant therapy is effective in the primary or secondary prevention of embolic accidents. In subjects older than 75 aspirin given in daily doses of 325 mg seems to give similar results. The risk of antithrombosis therapy must not be underevaluated. The alternative is to maintain or restore the sinus rhythm, even at an advanced age, if the arrhythmia is recent and the left atrium is moderately dilated.