AF and Stroke Risk

“When you’re doing cardiac surgery you have the ideal opportunity to close the left atrial appendage in patients with atrial fibrillation”

Dr. Bart Maesen – Cardio-Thoracic Surgeon

Left Atrial Appendage (LAA)
is the primary cause of stroke in AF patients:1-5

Evidence in numbers:

91% of thrombus formations
were located in the LAA (review of 23 studies)1

5x greater risk of stroke
(and greater severity) in AF patients than non-AF patients, even after adjustment for other factors such as age, hypertension9-14

2x greater risk of mortality
caused by stroke than in non-AF patients9

40% reduced risk of stroke
originating in the LAA13

The 1-year mortality rate is reported to be nearly double in AF-related stroke patients compared to non-AF-related stroke patients.Adapted from Reference 7

PM-EU-3964A-0127-G
*Dr. Bart Maesen is a paid consultant for AtriCure. The content presented represents the professional opinion of the speaker and not necessarily that of AtriCure. AtriCure only promotes the on-label use of its products. Please exercise your own independent medical judgement.

References

Clinical results are not predictive and individual results may vary.

  1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755-759.
  2. Glikson M, Wolff R, Hindricks G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update. EuroIntervention. 2020;15(13):1133-1180.
  3. Hanke T. Surgical management of the left atrial appendage: a must or a myth? Eur J Cardiothorac Surg. 2018;53(suppl_1):i33-i38.
  4. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human agachment! Surgical implications. Eur J Cardiothorac Surg. 2020;17(6):718-722.
  5. van Laar C, Verberkmoes NJ, Es HW, et al. Thoracoscopic left atrial appendage clipping. JACC: Clinical Electrophysiology. 2018;4(7):893-901.
  6. Badhwar V, Rankin JS, Damiano RJ, Jr., et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac . 2017;103(1):329-341.
  7. Hindricks G, Potpara T, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. ;42:373-498.
  8. Writing Group M, January CT, Wann LS, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial llation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. ;16(8):e66-e93.
  9. Ali AN, Abdelhafiz A. Clinical and Economic Implications of AF Related Stroke. J Atr Fibrillation. 2016;8(5):1279. Authors pooled data from 15 studies.
  10. Health Policy Partnership. White Paper on inequalities and unmet needs in the detection of atrial fibrillation (AF) and use of therapies to prevent AF related stroke in Europe. 2018
  11. Cullen MW, Stulak JM, Li Z, et al. Left Atrial Appendage Patency at Cardioversion After Surgical Left Atrial Appendage Intervention. Ann Thorac Surg. 2016;101(2):675-681.
  12. Soltesz EG, Dewan KC, Anderson LH, Ferguson MA, Gillinov AM. Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage usion. J Card Surg. 2021;36(4):1201-1208.
  13. Whitlock RP, Belley-Cote EP, Paparella D, et al. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021;384(22): 2081-2091.
  14. Wolf PA, Abbog RD, Kannel WB. Atrial fibrillation is an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22:983-8.

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