Stroke, Vol 21, 4-13, Copyright © 1990 by American Heart Association
P Petersen
I review the present understanding of thromboembolic complications and
their prevention in patients with nonrheumatic atrial fibrillation. Chronic
atrial fibrillation carries an annual 3-6% risk of thromboembolic
complications, which is 5-7 times greater than that of controls with sinus
rhythm. Paroxysmal atrial fibrillation is associated with a lower risk of
thromboembolic complications than chronic atrial fibrillation. Heart
failure and systemic hypertension seem to be significant clinical risk
factors for stroke in patients with atrial fibrillation, but disagreement
persists, and, with few exceptions, subgroups at particular risk have not
been convincingly identified. The risk of stroke in persons with thyrotoxic
atrial fibrillation seems to be lower than believed previously. Clinical
studies have shown that left atrial dilatation is a consequence of the
duration of atrial fibrillation rather than a cause, but the relation of
left atrial enlargement to stroke is uncertain. Cerebral blood flow may be
reduced during atrial fibrillation but seems to increase after
cardioversion to sinus rhythm. A high prevalence of silent cerebral
infarction has been detected in patients with chronic atrial fibrillation,
but there seems to be a low risk of silent cerebral infarction in persons
with paroxysmal atrial fibrillation. The one prospective study published to
date on stroke prevention in patients with nonrheumatic chronic atrial
fibrillation showed that anticoagulation with warfarin significantly
reduced the incidence of thromboembolic complications.
ARTICLES
Thromboembolic complications in atrial fibrillation
Department of Neurology, University Hospital, Rigshospitalet, Copenhagen, Denmark.
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