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Atrial fibrillation - patients at high risk for cerebral embolism

P Bernhardt1, H Schmidt, T Sommer

  • 1Department of Medicine-Cardiology, University of Bonn, Germany. bernhardt@cardiovasc-mri.com

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|April 7, 2006
PubMed

Insights

Patients with atrial fibrillation (AF) face a high risk of cerebral embolism, even with oral anticoagulation. Echocardiographic factors like left atrial thrombi identify those needing closer monitoring for embolic events.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Atrial fibrillation (AF) patients have a significant risk of cerebral embolism.
  • Echocardiographic parameters are known risk factors, but long-term silent embolism rates under anticoagulation are unclear.

Purpose of the Study:

  • To assess the prognosis of AF patients.
  • To identify high-risk groups for cerebral embolism during oral anticoagulation.
  • To evaluate the rate of clinically silent cerebral embolism.

Main Methods:

  • 128 patients with AF and echocardiographic risk factors (left atrial thrombi, dense spontaneous echo contrast, reduced LA appendage emptying velocities) were studied.
  • 114 AF patients without these risk factors served as controls.
  • All patients underwent transesophageal echocardiography, cranial MRI, and clinical assessment over three years.

Main Results:

  • In the high-risk group, 5% experienced clinically apparent cerebral embolism, and 13% had silent embolism detected by MRI over three years.
  • The overall embolic event rate in the high-risk group was 21%.
  • Previous thromboembolism was a significant predictor of embolic events.

Conclusions:

  • Persistent or permanent AF with specific echocardiographic findings indicates a substantially increased risk of cerebral embolism (21%) despite oral anticoagulation.
  • Previous thromboembolic events are a critical predictor for future embolic events in AF patients.
Abstract

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