Dr Sanjay Gupta.."why I don't believe... - Atrial Fibrillati...
Dr Sanjay Gupta.."why I don't believe AF causes strokes"
Wow! Interesting!
However, I thought it was the fast pumping of the AF heart not clearing all the blood, that then clotted that caused strokes.
Me too - the irregular rhythm meaning some blood pooling in the Left Atrial Appentage (LAA) thereby and the irregular sending out a clot/clots
So did I. How interesting indeed!
Very interesting and very persuasive points - all so obvious when it is explained.
Thank you for posting it Steve.
Great video. Thank you.
"It is not the AF which causes strokes it is the company it keeps," This is not the first time I have heard that statement in the last year nor even the last month. Be very careful how you listen to this video and don't jump to conclusions. The title does not reflect the content.
The way I interpreted it was that ad alone raises no significant risk of stroke, however other co morbidities along with af are the main culprits,
I thought so too juggsy until I remembered his comment (often quoted elsewhere) that AF increases the risk of a stroke fivefold.
The way I understand that is that if your risk is statistically zero, than 5 times 0 is still zero. I did often wonder why CHADS2VASC didn't have a CHADS2VASCAF component.
Because CHADS2VASC only comes into play if you have AF. As you say five times zero is zero. CHADS2VASC is a score which can't be cancelled as well remember . Once give always held which is why if you have a score of 3 say and ablation removes your AF you are still at risk and still need anticoagulation. If your score was zero and you only went on anticoag for the ablation then it is still zero and you don't need it afterwards.
I know that there is work in progress to try to forecast stroke risk for those without AF but as of now such system doesn't exist.
Been thinking of you how are you doing now since your ablation with dr Ernst.
I only had AF and had a stroke - one of the low percentage
Excellent video. Thanks for sharing. Any day I get to watch Sanjay is a good day 
Maybe I'm missing the point, but got to say I'm utterly confused by this video.
Dr Gupta starts off (@ 01:50) by saying in an emphatic tone, that AF, definitely, without any doubt, raises your risk of a stroke 5 fold. Then finishes off with evidence that AF in itself plays no part in a stroke, it's all down the the other things you might have.
I wonder whether there was a fault in the study? There seems to be little medical reasoning in this video, just the use of statistics. No mention of the pools of blood that we are told occurs due to AF and that can then break off and cause a stroke even if you haven't had AF lately.
Like others on here, my EP has had me anticoagulated throughout, including before, during, and after ablation, even with a CHADS score of zero (now 1, when I reached 65 last year). Should we be asking our EP's to review this decision? I'd sure like not to take drugs if possible.
Koll
Wow.. The co morbidity makes a lot of sense. How to translate probable causation factors is always the question.
All made perfect sense to me. A few points though:
This "5 times more likely to get a stroke if you have AF" warning appears to apply to ALL people who have AF irrespective of if they have comorbidities or not. If it was separated into 2 classes, those with AF and NO comorbidities would be like any other person, whereas those with comorbidities would be up at 10 times or even more likely to get a stroke. The 5 x is generalization that covers everybody and is misleading as a result.
How to detect which class you are in? Well things like diabetes and high blood pressure are easy to test for and reflect in your CHAD score. However, there are others, leaky valves being one common example, so it seems an echocardiogram is necessary to establish whether you have comorbidities or not. I had one when I was first diagnosed with AF and I was 'clear' of any issues, but I'm now thinking that if one is going to make a decision about whether to go onto anti-coags are not, more regular echocardiograms should be taken to see if anything has changed as you get older.
The only thing missing in the video was the 'pooling of blood' in AF. I would have liked it if there was an opinion on this. Is it a potential problem or not, or do the comorbidies have to exist for it to be a problem, which is what I'm assuming by its absence from the video?
PS: I'm coming up to 65 (a young 65 I might add) and so will go up to a score of 1. I am going to consult with my GP again about anti-coags, but based on previous discussions I believe he'll say there is still no need. This video has led me to believe that when I enter that 'grey' area of whether to anti-coag or not, I should first go for another echocardiogram to help with that decision, even if I have to pay for it myself.
There was one point I didn't totally agree with. There was a reference to strokes (not) happening during AF as an argument to disassociate stokes with the actual AF. My understanding is that the clot can occur during AF, but that it may be some time later when you are back in NSR that it breaks free and causes the stroke.
Interesting. why aren't patients with those other problems such as diabetes and high BP given anti-coagulants then as well?
The latest stroke guidelines from the Royal College of Physicians at para 5.7 state: "In about a quarter of people with stroke, and more commonly in younger age groups, no cause is evident
on initial investigation. Other causes that should be considered include paroxysmal atrial fibrillation (PAF)..." I had a stroke with blood pressure of 120/80, three hours of aerobic exercise a week, BMI of 25, 3.8 total cholesterol. I had AF when I exercised but it didn't cause a problem. However the ithlete app that measures the r-r interval for athletic training showed increasing errors before the stroke, even though my bradycardia pulse was normal and my sensitive heart monitor and blood pressure monitors were not indicating errors. Additionally one EP gave me a CHADVASC of 1 - I was aged 68 at the time - and specifically did not recommend an anticoagulant because I am a bleed risk. My stroke was described as a "random event". Trust me, don't risk disability by not taking an anticoagulant if you have AF. I'm lucky; I've only lost 50% of my sight and driving licence, it could have been much worse. If you're worried about reversibility because like me you're a bleed risk, discuss Dabigatran with your GP.
The comments here are definitely thought-provoking. My husband had a stroke when he was 82; only then was he diagnosed with atrial fibrillation. He is and was otherwise very healthy - normal blood pressure, no diabetes, no prescription medications for anything and a very healthy heart and heart rate. But he did periodically experience a rapid heart rate - unexplained and undetected by cardiologists over a period of more than five years even with 3-day heart monitoring at times. The discussion here would indicate that his only culpability for his stroke was his age and the undetected Afib as risk factors. He did have a cryoablation and now takes Apixaban/Eliquis to minimize the possibility of another stroke. The confusion about the exact relationship between Afib and stroke is understandable and worthy of more research.
Wow food for thought 🌺
I had my TIAs when everything else was normal except for the fact that I was in AF for most of the time. My blood pressure was if anything, low. My lifestyle was healthy and my BMI 21. The dopler scan of carotid artery was completely normal. I was 55.
In some ways I would like my AF to have been the cause because , being now anticoagulated, I would feel I had done everything to protect myself whereas if they were random events I am less confident that I can prevent more.
It is an interesting topic worthy of more investigation. X
Hallelujah.
I'm delighted that he highlighted the landmark paper published in the New England J of Medicine in 1989. Here is my interpretation. In that study they recruited 3,623 patients with lone atrial fibrillation, all under the age of 60, with a CHAD2VAS2 score of 0.
They followed the cohort for 15 years. Only 1.3% of the original patients had a stroke ... *after 15 years*. Remember: this isn't the annual stroke risk - it is the risk over 15 years! Not only does this extremely low figure contradict the widespread misconception that "AF gives you 5 times the risk of stroke" but that stroke risk is a lot lower than the average stroke risk in the general population. Presumably, that's because the general population includes people with risks such as diabetes, high blood pressure and so forth. But if there is one take-home message of his video it is this: having AF on its own does not increase your stroke risk.
Instead, the CHAD2VAS2 score gives your stroke risk. Yes the presence of AF is important because it tends to be *correlated* with other health problems associated with stroke. AF is like a "red flag". If you have AF, watch out for other co-morbidities - your body is telling you something.
Arguing that AF itself causes stroke misses the point. It is a bit like concluding that the peptic ulcer that you got from smoking cigarettes "caused" your lung cancer.
The final study examined people with a pace maker but no AF - they were 100% sure there was no "silent AF" because the pace maker would have picked it up. Considering their CHAD2VAS2 score (which of *course* can be calculated in people without AF), it turned out their risk of stroke was *identical* to the risk of stroke in a matched population of individuals with the same CHAD2VAS2 score but who had AF. In short, the presence or absence of AF was irrelevant to stroke risk.
This should finally dispel the misconception that AF automatically gives you a 5-fold risk of stroke, and the confusing belief by some that the CHAD2VAS2 score is somehow "on top" of this already 5-fold increase. Wrong: the CHAD2VAS2 score *is* your stroke risk, period - AF does not confer an additional risk beyond what the CHAD2VAS2 score tells you.
One important conclusion is that CHAD2VAS2 score is very useful for people without AF, and it is increasingly being used as a tool to assess stroke risk in all people, regardless of whether they have AF.
So if this is correct, the chads-vasc criteria should be applied to all people and not just those with AF. Would those without AF but high chads-vasc scores be put on anticoagulants?
But is there not a bigger risk of stroke if you are in permanent AF AND you have a stroke ? How can this be explained...esp. when there are no other factors such as high blood pressure so litle/no risk?
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