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Review
. 2024 Mar 26;60(4):536.
doi: 10.3390/medicina60040536.

Atrial Fibrillation Burden: Impact on Stroke Risk and Beyond

Ahmed AlTurki  1   2 , Vidal Essebag  1   3
Affiliations
Review

Atrial Fibrillation Burden: Impact on Stroke Risk and Beyond

Ahmed AlTurki et al. Medicina (Kaunas). .

Abstract

Atrial fibrillation (AF) is an important independent risk factor for stroke. Current guidelines handle AF as a binary entity with risk driven by the presence of clinical risk factors, which guides the decision to treat with an oral anticoagulant. Recent studies in the literature suggest a dose-response relationship between AF burden and stroke risk, in both clinical AF and subclinical atrial fibrillation (SCAF), which differs from current guidance to disregard burden and utilize clinical risk scores alone. Within clinical classification and at the same risk levels in various scores, the risk of stroke increases with AF burden. This opens the possibility of incorporating burden into risk profiles, which has already shown promise. Long-term rhythm monitoring is needed to elucidate SCAF in patients with stroke. Recent data from randomized trials are controversial regarding whether there is an independent risk from AF episodes with a duration of less than 24 h, including the duration of SCAF greater than six minutes but less than 24 h.

Keywords: anticoagulation; atrial fibrillation; burden; subclinical atrial fibrillation.

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Conflict of interest statement

Essebag has received honoraria from Abbott, Biosense Medical, Boston Scientific and Medtronic. A. AlTurki declares no conflict of interest.

Figures

Figure 1
Figure 1
Impact of atrial fibrillation burden on cardiovascular outcomes. Adapted from Chew et al. [41], Steinberg et al. [42], Ganesan et al. [35].
Figure 2
Figure 2
SCAF burden and risk of stroke. (a) The risk of stroke associated with a SCAF burden ≥ 23 h in different studies compared to no SCAF. Risk of stroke in patients with SCAF ≥ 23 h (red) compared to no SCAF (blue). (b) SCAF and stroke: A temporal relationship based on data from (A) ASSERT, (B) IMPACT, and (C) TRENDS. All stroke or systemic embolism events are correlated with SCAF. SCAF = subclinical atrial fibrillation. Reproduced with permission from AlTurki, A.; Marafi, M.; Russo, V.; Proietti, R.; Essebag, V. Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future. Medicina 2019, 55, 611 [26].
Figure 2
Figure 2
SCAF burden and risk of stroke. (a) The risk of stroke associated with a SCAF burden ≥ 23 h in different studies compared to no SCAF. Risk of stroke in patients with SCAF ≥ 23 h (red) compared to no SCAF (blue). (b) SCAF and stroke: A temporal relationship based on data from (A) ASSERT, (B) IMPACT, and (C) TRENDS. All stroke or systemic embolism events are correlated with SCAF. SCAF = subclinical atrial fibrillation. Reproduced with permission from AlTurki, A.; Marafi, M.; Russo, V.; Proietti, R.; Essebag, V. Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future. Medicina 2019, 55, 611 [26].
See this image and copyright information in PMC

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