The Brain-Atrial Fibrillation-Recent Rehabilitation Axis: A Modern Approach

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major contributor to ischemic stroke, heart failure, hospitalization, and mortality. AF-related strokes account for approximately 20-30% of all ischemic strokes and are typically associated with more severe neurological deficits and poorer long-term outcomes. As the prevalence of AF continues to rise with population aging, optimizing both stroke prevention and post-stroke management has become increasingly important. This narrative review summarizes current evidence on AF in the context of ischemic stroke, with particular emphasis on anticoagulation, acute stroke management, and early neurorehabilitation. Special attention is given to the unique challenges of AF-associated stroke, including hemodynamic instability, recurrent embolic risk, bleeding risk during anticoagulation, and the need for individualized rehabilitation strategies. We also discuss interdisciplinary care models, including the Hemodynamic Gating Matrix and the Heart-Brain Team approach, as potential frameworks for integrating cardiovascular and neurological management during recovery. AF-related stroke requires coordinated care across cardiology, neurology, and rehabilitation medicine. A physiology-guided and interdisciplinary approach may improve functional recovery while maintaining cardiovascular safety in this high-risk population.