Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.
Gregory Yoke Hong LipMarco ProiettiTatjana S PotparaMoussa MansourIrina SavelievaHung Fat TseAndreas GoetteAlan John CammCarina Blomstrom-LundqvistDhiraj GuptaGiuseppe BorianiPublished in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (2023)
Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.
Keyphrases
- atrial fibrillation
- oral anticoagulants
- left atrial appendage
- direct oral anticoagulants
- catheter ablation
- left atrial
- heart failure
- percutaneous coronary intervention
- healthcare
- risk factors
- cardiovascular disease
- type diabetes
- metabolic syndrome
- case report
- physical activity
- acute coronary syndrome
- current status
- venous thromboembolism
- depressive symptoms
- weight loss
- quality improvement
- blood brain barrier
- blood pressure
- coronary artery disease
- health insurance
- left ventricular