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Updated: Dec 25, 2025

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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The Atrium and Embolic Stroke: Myopathy Not Atrial Fibrillation as the Requisite Determinant?

Jithin K Sajeev1, Jonathan M Kalman2, Helen Dewey3

  • 1Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia.

JACC. Clinical Electrophysiology
|March 21, 2020
PubMed

Insights

Atrial fibrillation (AF) may not be the sole cause of cardioembolic stroke. Adverse atrial remodeling, independent of rhythm, could be a key factor in clot formation and stroke risk.

Area of Science:

  • Cardiology
  • Neurology
  • Biomedical Science

Background:

  • Atrial fibrillation (AF) is linked to left atrial clot formation and cardioembolic stroke.
  • Subclinical AF contributes significantly to embolic strokes of undetermined source.
  • Recent trials showed limited benefit of anticoagulation for unselected stroke patients, prompting a search for better risk markers.

Purpose of the Study:

  • To review evidence questioning AF as the sole prerequisite for left atrial thrombogenesis.
  • To highlight adverse atrial remodeling, independent of AF rhythm, as a potential mechanism for stroke.

Main Methods:

  • Literature review of randomized control trials and observational studies.
  • Analysis of nonfibrillatory atrial electrical markers, structural, and biochemical abnormalities.
  • Exploration of the relationship between vascular risk factors, atrial remodeling, and thrombogenesis.

Main Results:

  • Inconsistencies exist in the evidence linking AF directly to left atrial thrombogenesis and stroke.
  • Nonfibrillatory atrial electrical markers and structural abnormalities are associated with ischemic stroke, independent of AF.
  • A complex interplay between vascular risk factors, atrial remodeling, and clot formation is evident.

Conclusions:

  • Atrial myopathy markers may enable early identification of patients at risk for cardioembolic stroke.
  • Adverse atrial remodeling, irrespective of AF presence, is a plausible mechanism for left atrial thrombogenesis and ischemic stroke.

Keywords:
ESUSatriummyopathystrokethrombogenesis

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