Harvard Heart Letter

Atrial fibrillation: The latest treatment trends

About one in six strokes can be traced to atrial fibrillation. Doctors now have newer and better options to lessen this risk.

Close to one in 10 people ages 65 or older have atrial fibrillation (afib), the most common heart rhythm disorder. During a bout of afib, the usually rhythmic contractions of the heart's upper chambers (the atria) are replaced by an ineffectual quiver. While the symptoms, which include a racing heartbeat, dizziness, and shortness of breath, are troublesome for some people, the real threat lies in the increased risk of stroke that accompanies the condition.

When the heart takes on the afib rhythm, blood does not completely move out of the atria. Instead, it tends to pool and clot in a pouchlike extension in the upper left quadrant of the heart, called the left atrial appendage. If these clots break loose, they may travel to the brain and cause a blockage. This is known as an ischemic stroke.

Importance of stroke prevention

Bouts of afib may be unpredictable, occurring only sporadically, or continue for many days at a time or even indefinitely. Either way, you are at risk for a stroke, says Dr. Moussa Mansour, associate professor of cardiology at Harvard-affiliated Massachusetts General Hospital. Your stroke danger is magnified when you also have other cardiovascular risks, such as high blood pressure, heart failure, previous stroke, vascular disease, or diabetes. Age plays a major role as well. For people ages 80 or older with afib, the risk of stroke rises significantly. Many strokes could be averted by detecting and treating afib, so doctors use a scoring system to help identify people at highest risk.

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