Managing Stroke Risk in Patients With Atrial Fibrillation

Cardiologist discusses risk of stroke with atrial fibrillation patient and the option for managing their arrhythmia safely

While Atrial Fibrillation or Afib can be a debilitating condition in certain patients, the significantly increased risk of stroke most immediately concerns an electrophysiologist. Most of the initial medical interventions for Afib address the issue of stroke.

Atrial fibrillation can cause blood to pool in the Left Atrial Appendage or LAA. This is a small offshoot of the heart that has no apparent use – much like the appendix in the abdomen. When blood pools in the LAA, the risk of clotting increases. When a piece of clot detaches, it can travel to the brain, blocking essential blood vessels and ultimately causing a stroke.

When the Patient Is First Diagnosed With Atrial Fibrillation

When they are first diagnosed with Afib, most patients will be placed on anti-clotting (blood-thinning) medications known as anticoagulants. Traditional anticoagulants include warfarin, the generic name for Coumadin. There is also a new generation of anticoagulants that is as, if not more effective, with fewer side effects. Along with antiarrhythmics or rate control medication, many patients find relief from Afib symptoms while also reducing the risk of a stroke.

However, not all patients will respond well to these medications. Some patients will have significant side effects; others will not see any relief, yet others will see the drug’s effectiveness diminish over time.

A procedure known as cardiac catheter ablation is often indicated for these patients. Catheter ablation is explained in greater detail here. Cardiac catheter ablation involves targeted heat or cold therapy to destroy malfunctioning heart tissue causing errant electrical impulses. Advanced mapping software can accurately pinpoint stray electrical signals in the heart and correct them in real-time.

Sealing the Left Atrial Appendage

While cardiac catheter ablation is very effective in improving or eliminating the symptoms of Afib, some patients still represent a high stroke risk, and sealing the left atrial appendage or LAA may be an excellent option for this patient. Currently, there are several treatments for LAA closure. The first such treatment is known as the Watchman. A tiny parachute-like device is threaded up a thigh vein and into the left atrium. After the device is placed, new scar tissue grows over it to create a complete seal.

The bottom line is that while Afib can alternately be mild or severe, even occasional symptoms should be evaluated by a qualified electrophysiologist. This is the first step toward being symptom-free and significantly reducing the risk of a debilitating or fatal stroke.

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