A fib and white matter

[Martin32]

After being diagnosed with a fib my cardiologist said he thought my chads2 score was 0 and Recommended no anticoagulant and I said I had had a MRI scan before which showed white matter on my brain after another scan it did show white matter and so my cardiologist gave me a score of 2 points and told me to anticoagulate straight away ,I wondered how many people with a fib are given a low score but could be in need of anticoagulants,does this mean we need to MRI all a fib patients

[BobD Volunteer]

Well that should have given you a score of 2 to start with as a prior stroke of which apparently you were unaware. Many people only discover they have AF when the have the stroke as it can be asymptomatic. My understanding is that it is not matter , rather lesions in the brain caused by a stroke which show up white on MRI scan.

There are many of use who believe that all AF patients should be on anticoagulants but it is a risk / benefit equation so we have to go with what we have as CHADSVASC.

[Martin32 in reply to BobD]

Thanks Bob my MRI was done in Italy and the doctor in England would only believe it if he saw it for himself on a new MRI but assured me it would be clear (don’t know how ) and I would stop anticoagulantion interestingly I have asked many doctors what came first the stroke or the a fib and no one can give me the answer but how many a fib patients have white matter that they don’t know about without a scan that can tell them that they are on a nil point score or at high risk ,another point doctors in Italy don’t use the chads2 chart if a fib anticoagulants is the way forward

[CDreamer in reply to Martin32]

Doesn’t the size of the white matter indicate whether or not it is of any significance? I only ask as I had several small areas show up on a recent scan but my neurologist told me that they were of absolutely no significance as they were very small and that you were ‘allowed’ up to one small area of white matter per decade of life before there was cause for concern. Being in my 7th decade 2 were of no concern.

As an MRI scan is an expensive and time consuming test, I do not see how that scanning every AF patient would be feasible? But I take the point that perhaps the criteria and advice for taking anti-coagulants may not be perfect.

[Hidden]

Martin32,

When I was first going dizzy and unsteady on my feet they found white matter on my MRI when they were looking to see if I had had a stroke or a TIA. They said that the scattered white matter was not an indication of a stroke and diagnosed it as damage to the small arteries in the brain and said it was Cerebral Vascular Disease.

They stated that over time most of us get some degree of white matter, however I was only 52 at the time. I had another scan last year, so 6 years after the first and the amount of white matter has now risen to moderate.

In relation to AFib I didn’t have my first one until 3 years ago so not sure in my case that they would be linked unless you are saying once you have white matter eventually you will have AFib. My thoughts are that they are both things you will possibly get as you get older.

[Martin32 in reply to Hidden]

We are around the same age are you on anticoagulants now and wonder if this would help with the white matter ,as white matter goes my English cardiologist said very rare to see white matter in some one in the fifties but when talking to the doctor in Italy he was saying normal with age and said also small vessel damage so you might be right about the age thing

[Hidden in reply to Martin32]

On Riveroxaban but didn’t get put on that until after my first cardioversion, I was put on Warfarin prior to that of course

[Martin32 in reply to Hidden]

The strange thing is your white matter was described as not a stroke and mine was so although we could have the same event each doctor calls it different and therefore can advise to anticoagulate or not ,scary

[MarkS]

I think your point is very valid. The "white matter"/lesions won't have come from a full blown stroke but from a TIA. I believe TIAs are considerably under diagnosed in AF. The symptoms are transient. There have been a lot of reports of people on this forum "greying out" or getting a dizzy spell, which is a symptom of a TIA. It passes in a minute or two and can be easily ignored. It leaves few symptoms however some damage will have been done to the brain. This damage can accumulate and is suspected of causing the increase in dementia with AF.

I think it does make anti-coagulation with CHADSVASC2 scores of 0 or 1 more advisable. Here is a paper with more detail, "Atrial fibrillation is associated with impaired cognitive function and hippocampal atrophy: silent cerebral ischaemia vs. Alzheimer's disease?":

academic.oup.com/eurheartj/...

[Martin32]

Brilliant report and reading it I would say a fib come before the white matter but as yet to be proved and yes you are right I think I must have had a TIA as no history of a stroke which again comes back to how many a fib patients have had a TIA and never been checked for white matter as my white matter although very small was consistent with a lack of blood flow threw the small artery in the brain ,does anticoagulants stop this event from happening as I saw a report that the quicker you were anticoagulanted the less chance of vascular dementia but thanks for the reading

[Hidden]

This makes me worry a bit about my daughter, who has had a very odd symptom after some recent stress, in which she simply couldn't, for weeks, read any text. Her eyesight was otherwise perfectly fine. They have done an MRI which found small areas of white matter but not of determined cause. She hasn't seen a specialist yet (NHS waiting lists!) but of course is worried silly. Now I'm wondering if she had a TIA that caused this. She knows about my AF, I just wonder whether she has it too... She's 41 this year so would be young for it, but it seems to run in the family. Sounds like it's something we might all find if we had an MRI - I have to say, I've never had one...

[millie-becca-187]

I had a MRI scan in Dec 2013 post having a cervical disc replacement. 3 days after the operation, I had a suspected stroke. Though it couldn't be confirmed. After the scan, which was done before the suspected stroke, It was pointed out to me that I too had 'insignificant' white spots on my brain and that they were nothing to worry about.

3 months later I was diagnosed with AF. I am female andwas 45 years old at that time.

Makes you wonder if they're all linked somehow.

[MarkS]

Anticoags can stop dementia. See this trial "Efficacy of Warfarin Anticoagulation and Incident Dementia in a Community-Based Cohort of Atrial Fibrillation":

ncbi.nlm.nih.gov/pubmed/293...

Good INR control (Time in Therapeutic Range) with warfarin was found to cut dementia risk in the top quartile by a third - i.e. to around the level in the non-AF population. It doesn't specify the TTR in this article but as it's a US study where INR control is not great, I assume anything more that 70% of time in range (2-3).

This study took 10 years, so there hasn't been enough time to assess NOACs yet but I imagine they would produce similar results.

[Martin32]

Again it makes sense to anticoagulate

all a fib patients as perhaps silent strokes or white matter goes unnoticed unless a MRI scan is done

[Jeff8288]

I had a mri scan after waking up one morning with vertigo. My neurologist sent me for the mri. It came back with quite a bit of white matter. He informed me that these were small strokes. I just know these were from my episodes of afib. I would get dizzy and almost pass out. Pounding in my head was bad. I kind of freaked out from seeing the scan. Had three ablations, none of which worked. Now in flecainide and haven’t had a episode since Dr put me on it after last ablation four years ago.