Opinion: Is It AFib That Causes Strokes, Or Maybe Something Else?

Mar 26
AFib News Blog
Opinion: Is It AFib That Causes Strokes, Or Maybe Something Else?

Posted by Mellanie at StopAfib.org on March 26,  2017  10:56am EST

**This blog post reflects the opinion of the author and does not necessarily reflect the opinions of the AHA**

I just returned from the American College of Cardiology (ACC) medical conference. Over the past six months, I have attended EP in the West in October, American Heart Association in November, AF Symposium in January, Western AF Symposium in February, and ACC in March; at these medical conferences, I have picked up on an emerging theme.

It started with research findings within the past year showing a lack of correlation between afib and the onset of stroke in many with implanted devices. It was confusing and perplexing that many strokes in those with afib were actually not correlated with their afib episodes. In fact, often the afib and stroke did not occur in the same 30-day period; in some cases, they occurred as much as a year apart. How could that be?

Last week, at ACC, I heard an emerging theme more and more prominently
— maybe afib is really a marker of underlying atrial disease (atrial myopathy) and the strokes are due to the atrial disease rather than the afib. In fact, afib may simply indicate advanced atrial disease. This could be a huge shift in thinking.  

Over the past couple of years, I’ve heard experts talk about PACs (premature atrial contractions) and atrial flutter as risks for stroke, too, and thus they may also be markers of advanced atrial disease.

Nothing will change any time soon — validation studies are required to more fully understand this. But, if true, what would be the implications for those with afib?

It’s too soon to tell, but from a practical standpoint, the practice of stopping anticoagulants after a successful catheter ablation may be first on the chopping block. While a successful ablation would mean that fibrosis buildup due to afib might stop, there might still be atrial disease that could lead to a stroke. Many doctors today continue patients on anticoagulants after a successful ablation, and that may become the norm if the problem truly is underlying atrial disease, with afib as a manifestation of it. (This flies in the face of a new study just presented at ACC that found no reason to continue anticoagulants after a successful ablation.)

Several past studies have shown that the CHA
2DS2-VASc score predicts stroke risk even in the absence of afib, which makes sense. As someone with a CHA2DS2-VASc score of 3 now, since recently turning 65, this research factored into my decision to resume an anticoagulant even though I haven’t had afib in 11 ½ years and no longer have a left atrial appendage (it was removed during my mini maze surgery).

Even the half dozen top afib and anticoagulant experts I talked with were split on their suggestions to me. Since I average about 100,000 miles per year of flying (with the risk of DVT & blood clots), have underlying heart disease, had afib (which appears to be a manifestation of advanced atrial disease), and there have been strokes in our family, I believe there is enough potential risk to justify an anticoagulant. I'm unwilling to wait for the evidence to pile up and become overwhelming.

What might this mean to you? If you have had afib for a long time, potentially allowing fibrosis to build up in your atria, even with a successful ablation or surgery it might still be worth discussing anticoagulants with your doctors. This new theme has me questioning whether taking the new anticoagulants as “pill-in-the-pocket” will ever become a viable treatment strategy.

This is just my opinion, and is provided as food for thought based on emerging themes from recent medical conferences. 

Mellanie True Hills

CEO, StopAfib.org

  • K9Trainer
    Interesting Reading.I had a Cryoablation 4 years ago at Mayo and prior to procedure found no underlying medical issue such as Atrial disease, Fibrosis, Heart Valve..Kept me on Warfrain for 1 year, been on 81 mg aspirin and 500mg magnesium...not a Flutter, knock on wood no AFIB episodes. CHAD score 1
  • Thumper2
    Mellanie, thank you for a well-written and interesting opinion article, and for being willing to resume taking an anticoagulant!All the best,Thumper2 (Judy)
  • cookieis
    thank you for sharing this mellanie,it really opens my eyes to other possibilities
  • Petehilton
    Thank you for your post.  I also had my atrial appendage removed and just choose aspirin as thinner.are you concerned by side effects of anti-coagulants?
  • hodaglefty
    My very limited, and unprofessional understanding of afib's possible relationship to causing or contributing to strokes has to do with the "mechanical" and chemical affects from incomplete or effective atrial contractions and the "pooling" of blood that results from this incomplete contraction and thus formulation of blood clots.
  • jsawdon
    Hi Melanie​thank you for the comments and insights. This is timelyn in that Gerard Muller just shared apiece that indicated A-Fib was only responsible for between 5 to 7.5% of strokes. I personally only take baby aspirin and i have increased from every other day to every day( i react to aspirin) due to my occasional spikes on the treadmill. i am not certain i would want to go back on warfarin anytime soon. thanks againJohn
  • grey_one
    Mellanie - Thanks for taking the time to share this with us!
  • Ghinion
    Thank you very much for your input.I follow your comments all the time.Delia
  • Jeanamo
    Melanie, this is certainly interesting!  If a-fib is an indictor of underlying atrial disease...atrial myopathy...I am curious as to why this myopathy does not show up on echocardiograms, nuclear stress tests, etc.?  After my 3rd ablation, my EP (whose opinions I value) actually gave me the option of stopping the anticoagulant as I was not having a-fib episodes.  I opted to continue taking Eliquis in the event that the a-fib should return at some time in the future. I feel much "safer" taking the anticoagulant.  I could tell that my EP was VERY pleased that I opted to continue taking it.  Perhaps he presented the option because of the expense involved and that can be significant for many people.  i realize that a-fib is stll a "mystery" in many ways..but like you, I will continue taking the anticoagulant until I am convinced that it is not necessary after many studies that confirm it. I am so glad that you are attending all the conferences that really keep you up-to-date on the most recent "thinking" and conclusions about a-fib...and that you are sharing them with us.  I hope that members of this forum are reading the blogs so that they can benefit from the posts here. Best regards, Jean
  • Doncar1023
    Thanks Melanie for this very valuable information. I was diagnosed Afib in 2006  went thru cardio version three times didn't work took some medication was placed on warfarin around maybe two years and last year my Cardiologist stoped me from doing it. I was prescribed Ramapril and the over the counter aspirin. I have at least twice a year of electrocardiograph still afib is there. I am doing walking everyday at least 15000 to 20000 steps average and doing household chores and Thanks God I don't feel shortness of breath, palpitation and chest pain. I have my own oximeter to find out my heart rhythm and always normal between 60 to100 beat. Any advice. Thanks and I do appreciate your help
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