Which type of stroke is a patient at risk for if atrial fibrillation is untreated

Every week, I see at least one or two patients in the hospital who have had a terrible stroke that can be linked to inadequate treatment of atrial fibrillation (AFib). As a physician, this is frustrating to me, because it’s very likely these strokes could have been prevented with the proper treatment of the AFib.

I hear a lot of reasons why it’s not treated. To be blunt, the reasons are generally nonsense.

Let me back up a bit. AFib is a condition that causes an irregular heartbeat. Often, the condition has no symptoms, but sometimes patients experience heart palpitations – a racing heart or what is sometimes described as a heart flutter. This can last a few seconds, or it can be more chronic, lasting longer and with increased frequency.

AFib can be associated with high blood pressure, coronary artery disease, diabetes, as well as a number of other medical conditions. It also tends to occur more commonly in older people.

With untreated AFib, blood flow in the top part of the heart (known as the atria) slows down. Sometimes, the slow blood forms a clot that can leave the heart and travel throughout the body. This is known in medical terms as an embolic event. When one of these clots reaches the brain, it can block a blood vessel and cause a stroke. The size and severity of the stroke depends on the size and location of the blocked brain vessel.

Preventing stroke caused by AFib

People with AFib are five times more likely to have a stroke than those without it. Patients who have AFib caused by heart valve disease are at the highest risk of having a stroke.

If you’ve been diagnosed with AFib, your physician will ask questions about your health and perform a physical exam to determine your risk for stroke. An ultrasound of the heart, known as an echocardiogram, will help identify if you have valvular heart disease.

Several exciting new treatments are available to reduce the risk of having a stroke due to AFib. This includes a new array of anticoagulants, or blood thinners. These drugs, which you might notice are heavily advertised on television, reduce the likelihood of strokes. This reduced risk of having a stroke is likely due to reduced formation of clots in the heart.

Also, these new medications appear to be safer than warfarin, an older medicine used for the same reasons. Other advantages to the new medications include:

• Reduced incidence of bleeding into the brain, as compared to warfarin.
• Regular blood monitoring is not necessary. (By comparison, monitoring is required when taking Warfarin.)
• Few interactions with food or other medications. (Warfarin interacts with many types of food and other medications.)

What can you do?

First of all, if you’ve been diagnosed with AFib, talk with your doctor about your health, your risk of having a stroke, and options to decrease your chances of having one. If it’s determined that a blood thinner is right for you, please take your medication as prescribed, unless you talk to your physician and he or she recommends you should stop taking them. Remember, the medications, often referred to as NOACs, are safe and they’ve been evaluated and approved by the FDA.

While all drugs carry some element of risk, I am very comfortable as a physician when I prescribe the NOACs. Their benefits and safety have been proven in several large clinical studies.

If you think you might have AFib, an irregular heartbeat sometimes accompanied by chest pain or dizziness, consult your primary care physician. Your physician will conduct an EKG, a test that monitors heart rhythm.

If an irregularity is found, you will likely be referred to a cardiologist. From there, you and the cardiologist can discuss the best treatment plan for you. That treatment might or might not include going on anticoagulant medications. Other medicines might also be used to control your irregular heartbeat.

No matter your situation, when you see your physician, arm yourself with information. Don’t be afraid to ask questions. Find out what type of AFib you have and how you can manage it. Make your treatment a collaboration between you and your physicians. Most of all, don’t stop taking the medications, unless you talk with your physician first.

The risk is real. But fear of stroke doesn’t have to rule your life. Understand the link between atrial fibrillation and stroke, learn about preventing a stroke, and find out what you can do to reduce your stroke risk, below.

Risk of Stroke with Atrial Fibrillation

The average person with atrial fibrillation, or AFib, is 5 times more likely to suffer a stroke than someone with a regular heartbeat.1 Here’s why AFib stroke risk is so high:

In AFib, the upper heart chambers quiver and shake and do not contract, or squeeze, as they should.2 Because blood isn’t pumped out of the heart normally, it’s easier for blood cells to stick together and form clots in an area of the heart called the left atrial appendage.2,3

In people with atrial fibrillation not caused by a heart valve problem (also called non-valvular AFib), more than 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage.3 When a blood clot escapes from the left atrial appendage and travels to another part of the body, it can cut off the blood supply to the brain, causing a stroke.1,4

WATCHMAN and Stroke Risk

The WATCHMAN Implant is for people with atrial fibrillation not caused by a heart valve problem who need an alternative to blood thinners for stroke risk reduction.

Why Choose WATCHMAN

You are not alone. Hear from others about their experiences with AFib.

How Does Atrial Fibrillation Cause Stroke?

To better understand the connection between AFib and stroke risk, it helps to know a little about how your heart works. Your heart has an electrical system that controls the rate and rhythm of your heartbeat. In a healthy heart, the electrical signals produce a steady heartbeat. The heart contracts and pumps blood normally.4

With AFib, the electrical signals are disorganized. Atrial fibrillation happens when the top two chambers of the heart, the atria, beat rapidly and irregularly (fibrillate). AFib affects how well blood pumps through parts of your heart, which in turn affects your stroke risk. But proper treatment can help reduce your risk of stroke.4

Types of Stroke

There are 2 types of stroke: ischemic stroke and hemorrhagic stroke. An ischemic stroke is caused by a blood clot that lodges in a blood vessel and cuts off the blood supply to the brain. An ischemic stroke is the type of stroke most associated with the irregular heartbeat of atrial fibrillation.5,6

A hemorrhagic stroke is caused by bleeding in or around the brain. This can happen when a blood vessel in the area of the brain weakens and breaks. Blood builds and creates pressure on the brain, blocking blood flow.5,6

What Causes a Stroke?

Anyone can have a stroke regardless of age, race, or gender. But the chances of having a stroke are higher if you have certain stroke risk factors. Here are some of them5,6:

• Atrial fibrillation
• High blood pressure
• Diabetes
• Carotid artery disease
• High cholesterol
  

Stroke Warning Signs

Signs of a stroke may include the sudden onset of any of these symptoms5:

• Numbness or weakness of the face, arm, or leg
• Confusion, trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause

A stroke is an emergency situation. If you experience any of these symptoms, call 911 immediately.

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Management of Stroke

When a stroke happens, time is critical. Getting treatment right away can help reduce the effects of a stroke and may even prevent death. The gold standard for treating ischemic stroke (the kind caused by a blood clot) is a solution called tissue plasminogen activator. It’s administered through an IV in the arm, but it must be given within 3 hours of having the stroke.5

The effects of a stroke depend on where the blockage occurs in the brain and how much of the brain is damaged. These effects can include5:

• Paralysis
• Vision or speech problems
• Behavioral changes
• Memory loss

People who suffer a stroke often enter a rehabilitation program. Rehab can help those affected by stroke regain certain functions or learn how to live within their abilities.

Atrial Fibrillation and Stroke Facts

1. Stroke is the most common complication of AFib7
2. About one-third of people with AFib will have a stroke8
3. People with AFib have 5 times the risk for stroke than people with normal heart rhythms1
4. Strokes are more often fatal and disabling in people with AFib9
5. In non-valvular AFib, the left atrial appendage is the main source of stroke-causing clots that come from the heart3
   

Reducing Your Risk of Stroke With AFib

The good news is that the risk of stroke can be managed. There are different treatments available to reduce stroke risk if you have atrial fibrillation not caused by a heart valve problem (or non-valvular AFib). The most common way is with medications that prevent blood clots from forming and leading to a stroke. These medications, called anticoagulants or blood thinners, work well for many people. 1

But AFib is a lifelong condition and not everyone is able to take blood thinner medications long term.1 For these people, a procedure like WATCHMAN may be an option. WATCHMAN reduces the risk of stroke by closing off the left atrial appendage, where more than 90% of stroke-causing clots that come from the heart are formed.3

Your doctor will help you choose a treatment to reduce your stroke risk based on your heart’s rhythm, your symptoms, and any other conditions you may have.

Preventing a Stroke

Management of stroke risk is a main goal of AFib treatment. But there are a number of other things you can do to help reduce your overall stroke risk.5

• If you smoke, try to quit
• Get regular physical activity (ask your doctor what is safe for you)
• Eat a diet that is low in fat and salt
• Maintain a healthy weight  

You may not be able to change the fact that you have atrial fibrillation, and the risk of stroke that comes with it. But these healthy choices can have a positive effect on other health conditions, like high blood pressure, that further increase your stroke risk.5

Questions to Ask Your Doctor

If you have atrial fibrillation and you’re concerned about your stroke risk, here are some questions to ask your cardiologist: 

• What is my risk of having a stroke?
• What do I need to know in the event of a stroke?
• What treatment options can help reduce my stroke risk?
• Do I need a blood thinner and, if so, what kind?
• What are the alternatives to blood thinners?
• What are the risks and benefits of these treatment options?
• Are there lifestyle changes I can make to help reduce my stroke risk? 

If you need an alternative to blood thinner medications to reduce your stroke risk due to AFib, find out if the WATCHMAN Implant could be right for you. 

WATCHMAN is for people with atrial fibrillation not caused by a heart valve problem who need an alternative to blood thinners. This website is intended to provide patients and caregivers with some information about the WATCHMAN Implant. It may help prepare you for talking to your doctor about your options for reducing stroke risk.

Important Safety Information

The WATCHMAN and WATCHMAN FLX Devices are permanent implants designed to close the left atrial appendage in the heart in an effort to reduce the risk of stroke.

With all medical procedures there are risks associated with the implant procedure and the use of the device. The risks include but are not limited to accidental heart puncture, air embolism, allergic reaction, anemia, anesthesia risks, arrhythmias, AV (Arteriovenous) fistula, bleeding or throat pain from the TEE (Trans Esophageal Echo) probe, blood clot or air bubbles in the lungs or other organs, bruising at the catheter insertion site, clot formation on the device, cranial bleed, excessive bleeding, gastrointestinal bleeding, groin puncture bleed, hypotension, infection/pneumonia, pneumothorax, pulmonary edema, pulmonary vein obstruction, renal failure, stroke, thrombosis and transient ischemic attack. In rare cases death can occur.

Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the implantation of the device.

References

1. National Stroke Association. Making the Afib-Stroke Connection. https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf. Published 2012. Accessed September 1, 2016.
2. Harvard Health Publications. Atrial fibrillation. http://www.health.harvard.edu/heart-health/atrial-fibrillation-common-serious-treatable. Harvard University Medical School. Published November 2011. Accessed August 25, 2016.
3. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755-759.
4. Cleveland Clinic. Atrial fibrillation (Afib). http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/atrial-fibrillation-afib. Published May 2015. Accessed August 25, 2016.
5. American Stroke Association website. http://www.strokeassociation.org/STROKEORG/. American Heart Association. Published 2017. Accessed May 31, 2017.
6. National Stroke Association website. http://www.stroke.org/. Published 2017. Accessed May 31, 2017.
7. American Heart Association. FAQs of Atrial Fibrillation. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_424424.pdf. Accessed June 9, 2017.
8. Brass LM. Chapter 18: Stroke. In: Zaret BL, Moser M, Cohen LS, eds. Yale University School of Medicine Heart Book. New York: NY. William Morrow and Company, Inc; 1992. http://cwml.med.yale.edu/heartbk/. Accessed May 18, 2017.
9. Medi C, Hankey GJ, Freedman SB. Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation. Stroke. 2010;41:2705-2713.

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