The Temporal Relationship Between Atrial Fibrillation and Ischemic Stroke

Abstract

It is well established that the presence of atrial fibrillation (AF) is associated with an increased risk of stroke; however, the precise role that AF plays in increasing this risk is less well understood. In particular, it is not fully known whether a temporal relationship between AF and stroke exists. Early clinical trials in this field were limited by their rudimentary tools for monitoring of AF recurrences. More recently, studies employing implantable cardiac rhythm devices have brought greater precision to our ability to accurately detect and quantify episodes of AF but have been restricted to patient populations with clinical indications for those types of devices.In the future, new monitoring modalities such as subcutaneous devices and external patches may allow us to extend precise arrhythmia monitoring to the broader AF population. Due to the relatively low rate of clinical events, large clinical trials or registries will be required to fully appreciate the temporal aspects of AF and stroke and alternative metrics for quantifying AF recurrences need to be explored.

Figure 1.. Examples of Atrial Tachyarrhythmia/Atrial Fibrillation (AT/AF) Diagnostics Available in Implantable Devices

Figure 2.. Full Disclosure of Atrial Tachyarrhythmia/Atrial Fibrillation (AT/AF) Recurrences Relative to Thromboembolic Events [denoted by Red Line(s)]

Figure 3.. Example of a Subcutaneous Arrhythmia Monitoring Device

Figure 4.. Examples of Atrial Fibrillation AF Burden Patterns Which Equate to an Average Burden Value of 50%