How Does Afib Cause Stroke

How Does Afib Cause Stroke – Around 2% of the European population suffers from atrial fibrillation, a heart disease that changes the heart’s rhythm and increases the risk of serious health complications. Currently, therapies to directly address arrhythmias are not used in all patients. The Atrial Fibrillation Network Association (AFNET) was the organization responsible for the EAST-AFNET 4 study, which aimed to determine whether systematic, early monitoring therapy in patients with atrial fibrillation (AF) prevents adverse outcomes compared with restrictive, usual care. Symptom-driven use of rhythm control therapy. The results of the main study and a careful subanalysis show that early, systematic use of rhythm control, added to the best currently available treatments, can reduce AF-related complications by one-fifth. The introduction of early rhythm control therapy in patients with atrial fibrillation can help reduce the devastating consequences of arrhythmias, such as cardiovascular death, stroke and heart failure.

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and disrupts the heart’s normal rhythm. AF causes an irregular (often abnormally fast) heartbeat, dizziness, and shortness of breath. Some people feel that their heart is pounding or beating irregularly, while others have no symptoms.

How Does Afib Cause Stroke

Although AF is often unrecognized, the so-called asymptomatic AF, even these silent forms of arrhythmia can lead to cardiovascular death, stroke or heart failure.

Time Trends In Atrial Fibrillation Related Stroke During 2001–2020 In Sweden: A Nationwide, Observational Study

Normally, the heart muscle contracts and relaxes to allow blood to flow in and out of the heart. In AF, the upper chambers of the heart, called the atria, are activated randomly. They stop contracting and the ventricles, the main chambers of the heart, contract irregularly. This means that the heart cannot fully relax during contractions, reducing its effectiveness and efficiency.

The number of patients diagnosed with AF is increasing in Western countries, and the prevalence of AF is estimated to increase by 250% by 2050.

Atrial fibrillation is the most common type of cardiac arrhythmia and disrupts the heart’s normal rhythm.

Treatment includes ruling out other causes of AF, such as an overactive thyroid. In addition, AF-related strokes can be prevented by taking blood-thinning medications (anticoagulants). In addition, reduction of the rapid heart rate during AF with medication (“rate control therapy”) and recognition and therapy of the cardiovascular condition are important components of treatment in patients with AF.

Facts And Statistics About Atrial Fibrillation

In atrial fibrillation, the upper chambers of the heart (atria) do not pump efficiently. This increases the risk of blood clots. Clots in normal circulation can block arteries in the brain and cause a stroke. Alila Medical Media/Shutterstock.com

In addition, antiarrhythmics, cardioversion, and atrial fibrillation ablation are available to restore and maintain a normal heart rhythm in patients with atrial fibrillation. This treatment is called rhythm control therapy. Twenty years ago, many controlled trials found no clinical benefit of rhythm control therapy. Some early studies suggested that rhythm control therapy was associated with higher hospitalizations. Therefore, most patients do not currently receive rhythm control therapy. Rhythm control is limited to symptomatic patency. Before the EAST-AFNET 4 trial, there were only small studies in special AF patient populations, e.g. In patients with AF and heart failure, the incidence of cardiovascular events was reduced.

One of the risks associated with AF is an increased chance of stroke: individuals with AF are five times more likely to have a stroke than others. Therefore, many treatments focus on managing this risk. This is currently achieved mainly through the use of blood thinners, which prevent the formation of blood clots that can lead to stroke. They may also be given medication to slow the heart rate.

Despite these treatments, people with AF are at increased risk for heart and circulatory problems. This risk also increases during the first year after diagnosis, a period often referred to as “early atrial fibrillation.” Adverse events such as heart failure, stroke, and death continue to occur, suggesting that current approaches to treating AF require further optimization as new drugs and treatment techniques become more available.

How Is Atrial Fibrillation Characterized?

Despite the findings from older “rate versus rhythm” control studies, the investigators of the Early Treatment of Atrial Fibrillation for Stroke Prevention (EAST-AFNET 4) trial and others were aware of mechanistic research suggesting that sinus rhythm is better for the heart and for patients. with AF rather than persistent atrial fibrillation. These considerations led to the design and execution of the EAST-AFNET 4 study.

Previous studies have suggested that rhythm control therapy is recommended only to reduce AF-related symptoms, although it has the potential to reverse arrhythmias. The results of these studies also indirectly show that rhythm control therapy, used in conjunction with anticoagulants, helps prevent blood clots and maintain sinus rhythm (normal heart rhythm).

The EAST-AFNET 4 trials aimed to determine whether restoring a normal heart rhythm soon after AF diagnosis can reduce the residual risk of medical complications.

To meet study inclusion criteria, patients had to have been diagnosed with AF one year prior to study entry, as well as cardiovascular disease such as previous stroke, diabetes, kidney disease, or other heart problems.

When Your Heart Rhythm Is Off

The participants were then randomly assigned to one of two groups: the first group received systematic early rhythm monitoring and the second group received usual care. Immediately after randomization, all patients will have the electrical signal causing the arrhythmia and the faulty electrical signal causing the arrhythmia stopped. Early rhythm control involves treatment with either atrial fibrillation ablation (a procedure in which damaged heart tissue is carefully removed) to stop the electrical signal. The choice of treatment was decided by the patient care team. Treatment was adjusted based on the detection of recurrent episodes of AF: 95% of patients randomized to initial rhythm control received rhythm control therapy.

The usual care group received anticoagulation, rate control, and therapy for concomitant cardiovascular conditions, with patients randomized to initial undifferentiated rhythm control. Rhythm control therapy was used only to improve symptoms related to atrial fibrillation, according to current guidelines. Overall, only one of seven patients randomized to usual care received rhythm control therapy.

The researchers recruited 2,789 patients from 135 different centers in 11 countries, and the patients were followed for an average of 5.1 years.

The results of clinical trials have shown that treatments that normalize heart rhythm have reduced the risk of cardiovascular complications, including stroke and cardiovascular death, by approximately 20%. This improvement was observed in a wide range of patients with AF, including those who were asymptomatic, with and without heart failure, and patients with normal heart rhythm at randomization.

Ischemic Stroke With Atrial Fibrillation: Characteristics And Time Trends 2006 To 2017 In The Dijon Stroke Registry

The researchers also investigated possible reasons for the clinical benefits seen with early rhythm control. They found that there were no differences in other cardiovascular treatments, such as anticoagulant drugs, which could explain the differences between the control and initial therapy groups.

Finally, both treatments were equally safe for patients. Although there were fewer deaths in patients treated with early rhythm control therapy than in the usual control group, this was not statistically significant.

Overall, early rhythm control therapy was found to be safe, patients did not require a longer hospital stay, and the risk of adverse cardiovascular outcomes was lower than usual care in patients with newly diagnosed AF and cardiovascular conditions.

The EAST-AFNET trial 4 provides evidence that initiation of rhythm control therapy soon after diagnosis can improve patient outcomes. rumruay/Shutterstock.com

Atrial Fibrillation And Mechanisms Of Stroke

A subanalysis including 798 patients from the EAST-AFNET 4 study also supports this finding in patients with heart disease, suggesting that the presence of other medical conditions is not a contraindication to early rhythm control treatment. Early rhythm control also improved the composite outcome of death or hospitalization for heart failure.

A further subanalysis comparing asymptomatic and asymptomatic (or silent) groups of patients found no difference in outcome, suggesting that early, systematic rhythm monitoring is beneficial for all patients with newly diagnosed AF, regardless of their status. .

Currently, clinical guidelines recommend rhythm control therapy only for patients with persistent symptoms and for a small subset of patients with heart failure. If not, there is a delay in the healing process. This means that although rhythm control therapy has a positive effect on AF patients, it is used to treat one in seven AF patients in Europe.

The EAST-AFNET trial 4 provides evidence that initiation of rhythm control therapy soon after diagnosis can improve outcomes in patients with AF. This finding can be extrapolated to patients who are symptomatic or asymptomatic and holds regardless of co-existing conditions such as heart failure. The findings will inform clinical practice in patients with newly diagnosed atrial fibrillation.

Atrial Fibrillation & Afib Management

The study results were published at the same time as the 2020 European Society of Cardiology guidelines for atrial fibrillation were published. It will take some time to incorporate the findings into the new guidelines. I believe that international guidelines committees will be looking at updating their guidelines at this time.

Metzner, A, Suling, A, Brandes, A, et al, (2021) Anticoagulation, comorbidity and early rhythm control therapy: a detailed treatment analysis

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