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Published on: February 28, 2012
The Temporal Relationship Between Atrial Fibrillation and Ischemic Stroke
1Cardiac Rhythm Disease Management Division, Medtronic Inc., Mounds View, Minnesota 55112.
Insights
Atrial fibrillation (AF) increases stroke risk, but the exact timing and AF
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Atrial fibrillation (AF) is a known risk factor for stroke.
- The precise temporal relationship between AF episodes and stroke occurrence remains unclear.
- Previous studies were limited by suboptimal AF detection methods.
Purpose of the Study:
- To investigate the temporal relationship between atrial fibrillation and stroke.
- To highlight the need for improved AF monitoring techniques.
Main Methods:
- Review of early clinical trials with rudimentary AF monitoring.
- Analysis of studies utilizing implantable cardiac rhythm devices for AF detection.
- Discussion of emerging monitoring technologies like subcutaneous devices and external patches.
Main Results:
- Early AF monitoring tools lacked precision.
- Implantable devices improved AF detection but were limited to specific patient groups.
- Future monitoring modalities promise broader application.
Conclusions:
- Accurate quantification of AF burden is crucial for understanding stroke risk.
- Large-scale trials and novel metrics are needed to elucidate the AF-stroke temporal link.
- Advancements in monitoring technology will facilitate broader AF assessment.
Abstract:
It is well established that the presence of atrial fibrillation (AF) is associated with an increased risk of stroke; however, the precise role that AF plays in increasing this risk is less well understood. In particular, it is not fully known whether a temporal relationship between AF and stroke exists. Early clinical trials in this field were limited by their rudimentary tools for monitoring of AF recurrences. More recently, studies employing implantable cardiac rhythm devices have brought greater precision to our ability to accurately detect and quantify episodes of AF but have been restricted to patient populations with clinical indications for those types of devices.In the future, new monitoring modalities such as subcutaneous devices and external patches may allow us to extend precise arrhythmia monitoring to the broader AF population. Due to the relatively low rate of clinical events, large clinical trials or registries will be required to fully appreciate the temporal aspects of AF and stroke and alternative metrics for quantifying AF recurrences need to be explored.
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