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Medical and Device Therapy for Stroke Prevention in Patients With Atrial Fibrillation.

A trial fibrillation (AF) is the most common arrhythmia, affecting an estimated 2.2 million people in the United States (US) and 4.5 million people in the European Union. It accounts for a third of hospitalizations for cardiac rhythm disturbances. During the last 2 decades, as the population has aged and the incidence of chronic heart disease has increased, hospitalizations for AF have increased by 66%. As a result, AF has been called a “disease of the elderly.” Atrial fibrillation is responsible for 1 in 6 strokes in the general population and for 1 in 3 strokes in the elderly (≥65 yr). Strokes related to AF are typically more severe than other types of stroke. Stroke and AF are strongly associated. Atrial f ibrillation impairs atrial contraction, which can disrupt coordinated myocyte activity, thus promoting hemostasis and increasing thromboembolic risk. A stroke can trigger AF by disrupting cerebral autonomic centers. Also, AF has been associated with other factors that contribute to strokes, including hypertension, coronary heart disease, valvular heart disease, and heart failure. Atrial f ibrillation commonly coexists with other atrial abnormalities, including impaired myocyte contractility, left atrial appendage (LAA) mechanical dysfunction, and chamber dilation. The LAA, a trabeculated cul-de-sac, is where 90% of clots that cause AF-related stroke form. Preventing AF-related stroke is a major aspect of AF management. Warfarin and novel oral anticoagulants (NOACs) are very effective at preventing AF-related stroke. When these agents are contraindicated or not tolerated, LAA closure is an option. We review these and other current options for preventing stroke in patients with AF.