Atrial fibrillation in stroke patients

Q. Why is atrial fibrillation particularly relevant in Stroke patients?

1. Atrial fibrillation is a risk factor for stroke – Yes – 15-20% of acute stroke patients present in atrial fibrillation. During atrial fibrillation clots form in the heart and can then be carried through the circulation towards the brain causing ischaemic stroke.

2. Because there is intervention and prevention available to prevent strokes in patients with atrial fibrillation – Yes – this includes anticoagulation treatment which usually begins about 2 weeks following the acute event, provided there is no contraindications to anticoagulation.

3. Atrial fibrillation is a common consequence of complications of Stroke – Yes – pulmonary embolism and infection are known to be associated with triggering atrial fibrillation.

4. It is easy to reverse atrial fibrillation in stroke patients back to sinus rhythm – No – it is not easy to reverse atrial fibrillation because this is often resistant to therapeutic manoeuvres to return the patient to sinus rhythm.

5. Because the tachycardia associated with atrial fibrillation is associated with increased risk of future stroke  and poor outcomes- Yes – controlling heart rate is also important as well as controlling heart rhythm as excessive tachycardia may lead to angina or low blood pressure. Controlling heart rate using anti-arrhythmic medications and other medical treatments will improve cardiac output and blood pressure.

6. Atrial fibrillation causes hypertension – No – the tachyarrhythmia associated with atrial fibrillation is much more likely to cause hypotension.

Archie is diagnosed with paroxysmal atrial fibrillation – this may have been the cause of his stroke.