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Atrial Fibrillation and Mechanisms of Stroke

Although the importance of AF partly derives from its strong association with ischemic stroke, there have not been as many advances in our understanding of the mechanisms of stroke in AF. Current views rest on a century old hypothesis that fibrillation of the atrium produces stasis of blood, which causes thrombus formation and embolism to the brain. When other abnormalities are acknowledged to play a role, the dysrhythmia is still considered the primary cause of thromboembolism. Although this formulation is intuitively appealing, recent work suggests that the pathogenesis of stroke in AF is more complicated and involves factors in addition to the dysrhythmia.

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 Atrial fibrillation and stroke: State-of-the-art and future directions

Atrial fibrillation (AF) and stroke remain a major cause of morbidity and mortality. The two conditions shared common co-morbidities and risk factors. AF-related strokes are associated with worse clinical outcomes and higher mortality compared to non-AF-related. Early detection of AF is vital for prevention. While various scores have been developed to predict AF in such a high-risk group, they are yet to incorporated into clinical guidelines. Novel markers and predictors of AF including coronary and intracranial arterial calcification have also been studied. There are also ongoing debates on the management of acute stroke in patients with AF, and those who experienced breakthrough stroke while on oral anticoagulants

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Atrial fibrillation (AF) is the most common sustained arrythmia and one of the strongest risk factors and causal mechanisms of ischemic stroke (IS). Acute IS due to AF tends to be more severe than with other etiology of IS and patients with treated AF have reported to experience worse outcomes after endovascular treatment compared with patients without AF.

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