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Risk Assessment of Stroke in Patients with Atrial Fibrillation: Current Shortcomings and Future Directions

Daniel A Hyman1, Vincent Siebert2, Xiaoming Jia3

  • 1Department of Medicine, Baylor College of Medicine, Houston, TX, USA. hyman@bcm.edu.

Cardiovascular Drugs and Therapy
|January 27, 2019
PubMed

Insights

Subclinical atrial fibrillation detected by implantable monitors challenges current stroke risk scores. New methods are needed to assess thromboembolic risk based on atrial fibrillation burden.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Atrial fibrillation is a major cause of cardioembolic stroke.
  • Current risk scores guide anticoagulation but exclude undiagnosed atrial fibrillation.
  • Implantable cardiac monitors enable detection of subclinical atrial fibrillation.

Purpose of the Study:

  • To evaluate the relationship between paroxysmal atrial fibrillation burden and thromboembolic risk.
  • To highlight the limitations of existing risk stratification systems in the context of subclinical atrial fibrillation.

Main Methods:

  • Analysis of data from implantable cardiac monitors.
  • Examination of episodes of paroxysmal atrial fibrillation and their correlation with thromboembolism.
  • Assessment of the total burden of paroxysmal atrial fibrillation.

Main Results:

  • Implantable monitors can identify subclinical atrial fibrillation.
  • Data suggests a link between atrial fibrillation burden and thromboembolic events.
  • Current risk scores do not account for atrial fibrillation burden or subclinical cases.

Conclusions:

  • Subclinical atrial fibrillation is detectable and may influence stroke risk.
  • Existing risk scores have shortcomings in managing patients with undiagnosed or subclinical atrial fibrillation.
  • Further research is needed to incorporate atrial fibrillation burden into stroke risk assessment.

Keywords:
Atrial fibrillationStroke risk stratificationSub-clinical atrial fibrillation

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