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Reducing Stroke Risk With Atrial Fibrillation (AFib)

Posted on May 21, 2021
Medically reviewed by
Larry A. Weinrauch, M.D.
Article written by
Joan Grossman

  • Atrial fibrillation (AFib) is associated with a high risk for stroke.
  • High blood pressure and diabetes increase the risk for stroke among people with AFib.
  • Blood thinners, surgical procedures, and lifestyle changes can reduce the risk of stroke.

Atrial fibrillation is a form of irregular heartbeat that increases the risk of stroke. The condition is caused by a disorder in the heart’s electrical system and starts in the atria, the two upper chambers of the heart. AFib is the most common form of arrhythmia — a type of heart disease. Symptoms of AFib include heart palpitations, fatigue, shortness of breath, and light-headedness.

AFib is associated with ischemic stroke, which is caused by an obstruction of blood flow to the brain due to a blood clot — a kind of embolism. Irregular heartbeat from AFib causes inefficiencies in the pumping of blood, which can result in blood pooling in the heart and causing a blood clot. Blood clots that form in the left atrium of the heart can dislodge, travel to the brain, and cause a stroke.

AFib affects approximately 2.7 million people in the United States. Although people with AFib have an increased risk for stroke, blood clots, and heart failure, risks can be reduced with medication, surgery, and lifestyle changes.

The Risk of Stroke With AFib

The risk of stroke among people with AFib is four to six times greater than the general population. The risk increases with age and other factors. AFib is the cause of approximately 25 percent of strokes in people over 80 years old.

The CHA2DS2-VASc Score

The CHA2DS2-VASc score is used to evaluate the risk of stroke with AFib. The term CHA2DS2-VASc stands for the conditions that affect risk: congestive heart failure, hypertension (high blood pressure), age, diabetes, stroke, vascular disease, and sex. Points are assigned to each risk factor. A higher point total indicates a higher risk of stroke:

  • Congestive heart failure — 1 point
  • Hypertension — 1 point
  • Age 75 or older — 2 points
  • Age 64 to 74 years — 1 point
  • Female — 1 point
  • Diabetes — 1 point
  • History of stroke, ministroke, or a blood clot — 2 points

Reducing the Risk of Stroke

The risk of stroke with AFib can be reduced with medication, surgery, and lifestyle changes.

Blood Thinners

Blood thinner drugs, also called anticoagulants, prevent blood from clotting and can reduce the risk of stroke in people with AFib by as much as 60 percent. However, blood thinners increase the risk of heavy bleeding from injury and internal bleeding, including intracranial hemorrhage (bleeding under the skull) which can be life-threatening.

The most common blood thinner is Coumadin (warfarin), which can be effective in reducing the risk of stroke. It can also be difficult to manage because it interacts adversely with many other drugs and foods.

A newer class of blood thinners — direct oral anticoagulants (DOACs) — have been shown to have less risk of intracranial hemorrhage, gastrointestinal bleeding, and other forms of bleeding. DOACs used for the treatment of AFib include Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban).

Surgical Procedures

AFib is caused by abnormalities in the heart’s electrical system, in which the signals for heartbeats do not function properly. Surgical procedures can block problematic signals and restore a regular heartbeat.

Ablation

Ablation, or catheter ablation, is a minimally invasive procedure in which a small tube (catheter) is inserted into a blood vessel in the groin to reach the heart. A tiny device uses heat (radiofrequency) or freezing (cryoablation) to create scars to disable areas of the heart muscle that may conduct abnormal signals.

Ablation is associated with a number of risks, such as infection, damage to blood vessels or the heart, blood clots, and radiation exposure.

Maze Surgery

The maze procedure, also called the Cox maze procedure, is a more elaborate and invasive form of ablation conducted as open-heart surgery. The procedure is usually only done when someone with AFib requires another form of invasive cardiovascular surgery, such as coronary bypass or heart valve surgery

In one study, the maze procedure had an 85 percent success rate after 10 years. It is considered a highly effective treatment for AFib when another heart surgery is indicated. The procedure has risks associated with open-heart surgery and general anesthesia, including infection, organ damage, stroke, and life-threatening complications.

Watchman

The Watchman device is a tiny pouch implanted in the heart to trap blood clots that may form in the left atrial appendage. The device is only appropriate for people whose AFib is nonvalvular, meaning it does not involve heart valves. The Watchman is considered as effective as some blood thinners, and it may be an option for people who cannot take blood thinners.

The Watchman is inserted through a catheter in a vein near the groin. Risks include misplacement of the device, a buildup of blood in the heart, and stroke.

A Healthy Lifestyle

Lifestyle modifications can help prevent or reduce incidents of AFib and the risk for stroke. Some of the most effective lifestyle changes for AFib include:

  • Quitting smoking
  • Avoiding excessive alcohol consumption
  • Avoiding stimulants like caffeine
  • Eating a heart-healthy Mediterranean diet to help lower cholesterol and prevent diabetes and obesity
  • Reducing stress through practices like yoga, mindfulness training, or psychotherapy
  • Maintaining physical activity, like walking or gardening

Maintaining Your AFib Treatment Plan

Stick to your treatment plan for AFib to help reduce your risk of stroke. Your treatment plan may include oral medications that you take once or more per day. In addition to blood thinners, you may be prescribed anti-arrhythmic medications, such as Cordarone (amiodarone), Multaq (dronedarone), or Tambocor (flecainide). You may also be prescribed other types of medications like beta-blockers or calcium channel blockers.

It is important to adhere to medication schedules and discuss any concerns with your doctors. Talk to your cardiologist about surgical procedures, and be sure you understand your options for treating AFib and reducing your risk for stroke.

Your health care team can refer you to other practitioners who may be helpful in the management of AFib, including nutritionists, physical therapists, or psychotherapists.

Recognizing the Signs of Stroke

It’s important for you and your loved ones to recognize the warning signs of a stroke so you can get immediate medical attention should you need it. You can remember the warning signs of a stroke using the acronym FAST:

  • Face drooping — One side of the face will droop or become numb.
  • Arm weakness — One arm may become numb or weak.
  • Speech difficulty — Speech will be slurred or difficult to understand, or speaking may become impossible.
  • Time to call 911 — If any of these warning signs occur, even if they go away, call 911 or emergency services immediately.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 36,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart diseases like AFib.

Are you living with AFib? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

  1. Atrial Fibrillation (AFib) — Cleveland Clinic
  2. Ischemic Stroke (Clots) — American Stroke Association
  3. Reduce Your Risk of Stroke if You Have Atrial Fibrillation — Mayo Clinic
  4. What Is Atrial Fibrillation (AFib or AF) — American Heart Association
  5. Atrial Fibrillation and Stroke Information Page — National Institute of Neurological Disorders and Stroke
  6. Atrial Fibrillation — Heart & Stroke
  7. Anticoagulation in Atrial Fibrillation — Current Concepts — Arrhythmia & Electrophysiology Review
  8. DOACs Now Recommended Over Warfarin To Prevent Blood Clots in People With Atrial Fibrillation — Harvard Medical School
  9. Comparison of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Bioprosthetic Heart Valves — The American Journal of Cardiology
  10. Atrial Fibrillation — UCSF Cardiac Surgery
  11. Atrial Fibrillation Ablation — Johns Hopkins Medicine
  12. The Cox-Maze Procedure for Lone Atrial Fibrillation: A Single-Center Experience Over 2 Decades — Circulation: Arrhythmia and Electrophysiology
  13. Heart Surgery — American Society of Anesthesiologists
  14. Left Atrial Appendage & Closure — Cleveland Clinic
  15. Ten Lifestyle Modification Approaches To Treat Atrial Fibrillation — Cureus
  16. The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription — International Journal of Environmental Research and Public Health
Larry A. Weinrauch, M.D. is an assistant professor of medicine at Harvard Medical School with a focus on cardiovascular disease and clinical outcomes research. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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