How Early Is Early Enough to Prevent Stroke in AF?
How Early Is Early Enough to Prevent Stroke in AF?
Evaluation of: Healey JS, Connolly SJ, Gold MR et al. Subclinical atrial fibrillation and the risk of stroke. N. Engl. J. Med. 366(2), 120–129 (2012).
Atrial fibrillation (AF) is a potent risk factor for stroke, being responsible for 20% of ischemic strokes. Subclinical AF burden has received much attention, especially in the context of patients with cryptogenic strokes. However, little is known about the impact of subclinical episodes of rapid atrial rate and the primary risk of stroke and systemic embolism. Healey et al. investigated whether subclinical rapid atrial rate detected by implanted devices was associated with the risk of ischemic stroke in patients without clinical evidence of AF. The current article discusses the potential implications of the above results.
Stroke accounts for approximately 5.5 million deaths annually worldwide. The overall risk for stroke among individuals with atrial fibrillation (AF) averages approximately 5% per year and is about five-to-six-times greater than the risk among age-matched people in sinus rhythm. Strokes in patients with AF tend to be more severe; they cause greater disability and have worse outcomes than strokes in patients in sinus rhythm. Stroke related to AF can be prevented through early detection of AF and subsequently early application of primary prevention strategies. However, many patients have silent/asymptomatic AF, and strokes are the first manifestation of the arrhythmia. Indeed, asymptomatic AF is likely to become persistent–permanent AF, increasing thromboembolic risk.
Some interest is focused on those patients at high risk of stroke without overt AF. There are several studies on high-rate atrial episodes or subclinical AF burden and the risk of stroke. Until now, the association between subclinical episodes of rapid atrial rate and the risk of stroke and systemic embolism (SE) has been unclear. Whether early thromboprophylaxis should be administered to patients with subclinical AF is also unclear.
The study under evaluation aimed to investigate whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of AF.
Abstract and Introduction
Abstract
Evaluation of: Healey JS, Connolly SJ, Gold MR et al. Subclinical atrial fibrillation and the risk of stroke. N. Engl. J. Med. 366(2), 120–129 (2012).
Atrial fibrillation (AF) is a potent risk factor for stroke, being responsible for 20% of ischemic strokes. Subclinical AF burden has received much attention, especially in the context of patients with cryptogenic strokes. However, little is known about the impact of subclinical episodes of rapid atrial rate and the primary risk of stroke and systemic embolism. Healey et al. investigated whether subclinical rapid atrial rate detected by implanted devices was associated with the risk of ischemic stroke in patients without clinical evidence of AF. The current article discusses the potential implications of the above results.
Introduction
Stroke accounts for approximately 5.5 million deaths annually worldwide. The overall risk for stroke among individuals with atrial fibrillation (AF) averages approximately 5% per year and is about five-to-six-times greater than the risk among age-matched people in sinus rhythm. Strokes in patients with AF tend to be more severe; they cause greater disability and have worse outcomes than strokes in patients in sinus rhythm. Stroke related to AF can be prevented through early detection of AF and subsequently early application of primary prevention strategies. However, many patients have silent/asymptomatic AF, and strokes are the first manifestation of the arrhythmia. Indeed, asymptomatic AF is likely to become persistent–permanent AF, increasing thromboembolic risk.
Some interest is focused on those patients at high risk of stroke without overt AF. There are several studies on high-rate atrial episodes or subclinical AF burden and the risk of stroke. Until now, the association between subclinical episodes of rapid atrial rate and the risk of stroke and systemic embolism (SE) has been unclear. Whether early thromboprophylaxis should be administered to patients with subclinical AF is also unclear.
The study under evaluation aimed to investigate whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of AF.
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