Stroke Risk in or out of AF

[SirBeatalot]

I have PAF and wondered if the risk of a stroke is the same when in Sinus Rhythm as it is when in AF?

I am sure I heard an Cardiologist say that this was the case or have I got this wrong.

[Jetcat]

Iv read different things on the subject. The majority have said we are, but some say we are not.!!!! I’d like to think we are not because I have LONE AFIB and my chads are nil so I also are not on any anticoagulants as my cardiologist took me off them for this reason 😙 it will be interesting to read any recent statistics though.

[SirBeatalot in reply to Jetcat]

Hi Jetcat.Thanks. I am on Apixaban awaiting an ablation, but as I have said to others I was hoping the increased stroke risk was only during the AF episode itself.

[Jetcat in reply to SirBeatalot]

Yes I hope it is too mate.👍

[BobD Volunteer]

You have AF you have a stroke risk is the general intelligence. The duration of and length of your AF events are not relevant. Remember many people have AF even when they are unaware of it so the risk remains.

Some people with a Chadsvasc score of zero may be anticoagulated for the period of treatment options such as DCCV (cardioversion) or ablation but if your score warrants them then you should take them.

[SirBeatalot in reply to BobD]

Hi BobD.Thanks, I am on Apixaban for life i guess.

[Hidden in reply to BobD]

I've read the duration of the afib is the relevant variable. The longer the afib the oonger the blood is stagnating and can form a clot.

[BobD Volunteer in reply to Hidden]

I would not agree. Also a lot of people have events of which they are quite unaware. I have heard of clots forming in 6 minutes.

[Hidden in reply to BobD]

Oh yeah....absolutely...so if that person only went into afib for two minutes that clot wouldn't form...if that clot formed sits in a fibrillating heart for two more hours its gonna be a scab getting pumped around. I mean it goes against common sense laws of physics to thing that the time is a factor in clotting.

[Paulbounce]

I'm not a medic but my understanding is yes. Even in sinus your risk is greater. Those who have a succesful ablation still take anticoagulant's.

If you have PAF I think it's worth a chat with your cardio about the matter.

For what it's worth (under medicial advice) I have stopped taking them for now. With PAF I would be back on them in a flash - no doubts at all.

I'm in sinus and have been for a few years - I still have my doubts though if I'm doing the right thing. Hindsite is a wonderful thing but it's hard to tell. I think you should discuss it with your doctor.

Paul

[SirBeatalot in reply to Paulbounce]

Hi Paul.Thanks for the reply.

I am on Apixaban but was hoping that the risk of stroke was only just during the duration of an episode of AF.

[Paulbounce in reply to SirBeatalot]

No worries SirBeatalot. I think us afibbers are more at risk of stroke regardless of being in afib or not. Bad news I know.

The other thing to consider is you may have an episode of afib and not be aware of it. A clot can form quickly so this is worth noting.

I moniter my heart once a day. It doesn't take long but would alert me to any problems. Again though I might miss one and be ok at the time I do so - 10 minutes later it might kick in. Who knows !

Having been in sinus (more or less) for a few years I seem aware the moment it starts - then it's PIP time on the spot (flec). Some say to wait 20 minutes to see if it rights itself first. For me personally I don't - it's down my neck before the blink of an eye. I always carry one in my back pocket - just in case.

It's worked so far but I know that can change. It's working atm though - long may it continue.

Have a lovely evening.

Paul

[irene75359 in reply to Paulbounce]

Exactly what I do; PiP at the first irregular thump! Only happens 3-4 times a year and always works within a couple of hours.

[SirBeatalot in reply to SirBeatalot]

I think my confusion lies with the fact that when the heart beats irregularly it often fails to pump away all the blood which can then pool and cause clots, but when the heart is back in sinus it is pumping the blood away and so clotting is not an issue.

[Jetcat in reply to Paulbounce]

I also wonder whether I should still be taking them too. Some folk don’t like the idea of been on them but I never had any problem with taking them.

[Hidden in reply to Jetcat]

I mean its either take the pill or do the things that create less risk by lifestyle. How much do the pills reduce risk and how much do other things decrease risk? Often the statistics on lifestyle and diet are better risk indicators than taking a drug...not nessisarily with this but with things like depression etc.... So you always have a choice ..not between drugs and a Brian clot but between drugs and other means to achieve the same goals. I mean obviously don't go against your doctors advice but if you weren't on anything and were still worried you could do the up most to reduce your risks in other ways. That's all anyone can do

[Finvola]

My understanding is that the risk is a feature which can only increase not decrease. So, out of sinus or in sinus, the risk is the same. Also, for example, hypertension carries the risk even after it has been treated and controlled. Dr Gupta quote: it's the company which AF keeps which carries the risk of stroke.

[SirBeatalot in reply to Finvola]

Hi Fintona.Thanks for the reply.

I was hoping the risk was only during the AF episode itself.

[Peony4575 in reply to SirBeatalot]

I do know that where intermittent anticoagulation is being trialled they anti coagulate for 30 days after the episode of AF . Not sure if that is to do with new clots forming or clots lurking in the atria which can be expelled at a later date and cause mischief

[Hidden in reply to Finvola]

That's because hypertension is a symptom..when you control the pain from a stab wound the knife isn't taken away. They don't address the cause of hypertension...hypertension is not a cause but a correlated thing with stroke..so just cos you blot out the symptoms doesn't make it better.

[opal11uk]

The stroke, blood clot, happens when during A/F the heart does not pump and circulate the blood, it pools and clots in the left Atrium (think thats right) and then once sinus rhythm is restored the heart pumps out the clot(s) and that in turn travels to the brain and a stroke is the result.

[The_Lord_is_with_Us]

I have AFIB. Went 10 years in sinus after second ablation ... taking no anticoagulants. If there was a risk ... the EP would have kept me on blood thinner, wouldn't he? Had no issues. The risk must be miniscule.

[secondtry]

It may be that your resting pulse rate in NSR is a relevant risk factor. If you have had AF and are on drugs that lower your bpm, say <55, and also you don't regularly raise it with moderate exercise, my simplistic opinion suggests that could increase your stroke risk. On the other hand, if your normal bpm is say 65 you may be better off.

[Silvasava]

Im in permanent aFib, discovered when I had a stroke -(thrombolised, no after effects) unfortunately now have DCM so no cardioversion or ablation. If I was back in sinus rhythm would I continue to take anti co- AG's? Hell yes! It's a small price to pay to avoid a stroke that can leave you partly paralysed and speechless. Look after your heart, it's the only one you've got.

[allotmentman in reply to Silvasava]

what does DCM mean?

[Silvasava in reply to allotmentman]

My apologies - it's Dilated Cardiomyopathy where the ventrical is enlarged and does not pump as efficiently

[allotmentman in reply to Silvasava]

thank you.

[momist]

Another slant to consider is that I have heard it suggested that:

Statistically, strokes suffered by those with AF are more likely to be serious and to kill, than the 'average' stroke risk.

I have no idea whether that is true, but if so it should be taken to heart (sorry about the pun).

[Jetcat in reply to momist]

Yes I believe it’s because the clot is usually larger when it’s originated from the heart and can do more damage to the brain.?

[Breezera]

As we all know here... in atrial fibrillation, blood can pool in the heart's upper chambers and form blood clots. If a blood clot forms in the left-sided upper chamber (left atrium), it could break free from that part of your heart (i.e. the left atrium or the left atrial appendage), enter your left ventricle and then travel to your brain.

A cardiologist once told me that the greatest time of risk for an AFib-related stroke to occur is the moment when the heart converts from AFib to normal sinus rhythm (NSR).

In my case, when my serious ischemic stroke occurred (March 2016), my heart was in NSR and had been in NSR for roughly 2 weeks. Moments before the onset of stroke that morning I was in bed and I arose to use the bathroom. My stroke came on while I was in the bathroom. Within about 90 minutes I was in hospital undergoing an endovascular thrombectomy, which, thankfully, was completely successful. Remarkably I came out of it with zero deficits.

Cheers Richard

[Silvasava in reply to Breezera]

Similar situation to me - mine was thrombolised too and no after effects. God bless our NHS

[Hidden]

Clots can form in the heart during an AF episode and then may or may not escape during or after the AF episode. I resisted anticoagulation because I mistakenly believed the risk of a clot and therefore a stroke diminished after a paroxysmal AF episode. One morning I woke up and I couldn't lift my left arm for 15 minutes. Luckily it was (only!) a TIA. I now take the anticoagulants. Please note- I took aspirin before which I now know is more likely to cause internal bleeding than NOACs and will not prevent AF induced strokes.