Is stroke inevitable?

My cardiologist is strongly recommending an ablation and I am considering it. My afib burden is rather high, probably in afib 1/3 of the time, nsr 2/3. Afib for me is a minor annoyance, doesn't affect my life very much, which is why I have not gone the ablation route. I am 65, healthy, and have tried most of the supplement regimes with not much success. Here is my question: The doc (obviously in an attempt to scare me) said that unless my afib was cured with an ablation, or I went on full time blood thinner, a stroke was inevitable, sooner or later. I have been under the impression from Han's books and this forum that stroke risk for LAF was not much, if any, higher than the general population.

Another question: How do the other docs at St. Davids in Austin compare to Natale? Specifically, Sanchez and Zagrodski(sp?).

There was a recent article in the NY Times that stated

Outside of surgery, a diagnosis of atrial fibrillation is recognized as a major risk factor. It is the cause nationwide of at least one out of six ischemic strokes, the most common type of stroke, which disrupt blood flow to the brain. Strokes that are linked to atrial fibrillation are often more debilitating and lethal than strokes attributed to other causes.

[well.blogs.nytimes.com]

Hans reported on the study from Olmstead MN here: <[www.afibbers.org]

Quote

The Mayo researchers made the following important observations:
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1. The observed mortality rate among the afibbers over a 25-year period was substantially lower (15.9%) than the mortality expected in a group of age- and sex-matched white Minnesotans (32.5%).
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2. The incidence of ischemic stroke (cerebral infarction) in the afib group was no greater (0.5%/person-year) than in the general population. The researchers conclude that, “This observation indicated that the pathophysiological mechanisms responsible for the development of a cerebrovascular event were unrelated to the continued presence of AF.” In other words, LAF as such is not associated with an increased risk of stroke.

3. The volume of the left atrium (LAV) is an important indicator of the risk of adverse events such as stroke, heart attack (myocardial infarction), and congestive heart failure. A LAV (indexed for age and body mass) equal to or greater than 32 mL/m2 was associated with a 4.46-fold increase in the probability of experiencing an adverse event.

4. All cerebral infarctions occurred in participants whose LAV prior to the incident was greater than 32 mL/m2.

5. No correlation between age or the number of years afib had been present (duration) and LAV was observed; however, there was a highly significant correlation between persistent afib and enlarged LAV.

6. The average age at which a stroke occurred in the LAF group was 77 years, not significantly different from that observed in the general population.

7. Eighteen participants died during the study; 9 of cardiovascular disease, 4 of cancer, and 4 of a respiratory tract infection.

The researchers conclude that LAV is an important predictor of the likelihood that lone afibbers will suffer adverse events (stroke, heart attack, etc) during their lifetime. It is far more important than age and left ventricular ejection fraction. They suggest that only afibbers with a LAV less than 32 mL/m2 should be classified as “lone”. These afibbers had a benign clinical course during follow-up, while afibbers with an elevated LAV at diagnosis or later during follow-up experienced adverse events.

My takeaway is that afib is generally a risk because of the illnesses it associates with. " None of the participants had coronary artery disease, hypertension, diabetes, mitral valve prolapse, congestive heart failure, or any other condition that would increase their risk of ischemic stroke (cerebral infarction). " So if you have none of these conditions AND your LAV < 32mL/m2, if I were in your situation, I'd feel comfortable not being anticoagulated.

George

Agreed George, I stayed off the anticoagulants for those exact reasons except for the time period around my ablations. It is a highly personal choice, but that being said there is no way I would miss the opportunity to get an ablation. All of a sudden you could be 70 and have multiple other risk factors. Jim Bob maybe what your cardiologist meant by "sooner or later" is that sooner or later your risk factors would naturally increase, and with it your chance of a stroke. I know it is not good to rely on any one persons experience, but I will say that my dad has had afib since before the advent of ablations. At 86 he has experienced a stroke and two silent heart attacks. His life experience would have been quite a bit better with an ablation.
Ron

Good information, gentlemen, thank you. Now, how does one determine the left atrial volume? I had an echocardiogram, but it has been a couple of years ago. Also there was the statement that the LAV is adjusted for age and body mass. I googled LAVI and there is a lot of very technical stuff out there. If I get my medical records of the echo, will I be able to determine my LAVI?

I don't know. Shannon is at a conference this week. Maybe when he gets back he can provide some info.

See p31 of this PDF. Evidently can be measured via MRI, CT or echo. Whether they measured on your echo is an open question. <[www.escardio.org]



Edited 1 time(s). Last edit at 09/12/2014 03:52PM by GeorgeN.

My echo showed the size in mm

Afhound,

I'm guessing that is diameter, not volume. See <[en.wikipedia.org]

George

Jim - The tendency to form clots depends on many factors including whether or not the individual's blood is thick and sticky... called hyperviscosity. As a general safe-guard, often afibbers are automatically prescribed an anticoagulant which absolves the prescribing physician of liability if that patient does form a clot and have a stroke or MI. That practice is not as prevalent now as it was ten or so years ago but now with the new anticoags such as Eliquis and Xalerto, it may become more common once again.

In past years, we've posted a great deal about natural types of remedies for keeping blood platelets slippery to avoid the clotting tendency but the most critical thing for anyone asking the question you have asked... is stroke inevitable? should address several factors important for overall health, regardless of whether they have afib or not.

Thick, sticky blood is influenced by many factors... most often by inflammation from a variety of sources.

Long ago, a post titled... Red Flags to Beat the Odds ... listed important marker tests to determine clotting risk. These tests are not routinely ordered by our doctors unless they practice preventive, holistic or functional medicine... but they should be considered essential. You have to request them; sometimes argue to get them.

As as follow up to Red Flags, a reminder post titled Sticky, thick blood - risk of stroke or MI
Was offered 2 years ago… and is as follows:

For new readers or for those who may have not been reading regularly and may have missed the many discussions about inflammation and sticky, thick blood leading to risk of stroke or heart attack, this is a reminder to become very knowledgeable on the key risk factors which can be identified by specific highly-sensitive tests.

Preventive medical care should be high priority and these tests should be routine, but apparently, there is more money to be made from having to stent or do bypass surgery. What other reason could there possibly be for not screening everyone with tests that truly are preventive indicators? Typically, unless you see a doctor who practices integrative/functional medicine, you’ll have to ask for these special tests and often pay out of pocket. It makes no sense that this is the case, but that’s the way it is. (Medicare pays for some but not all.) You can call the lab that routinely does your blood draws and ask which of these tests are covered by insurance and the cost if not covered. If you have to pay out of pocket, try to get as many as possible and eventually, all of them.

Afibbers, especially, should be screened routinely and if any numbers are out of range, then immediately take corrective measures to normalize the levels. Don’t rely that your cardiologist or internist is routinely checking. You have to be the one to make sure you know your numbers.

Overly sticky, thick, inflamed blood has a tendency for adverse clotting. Test, don’t guess.
INR measurements while on warfarin/Coumadin only indicate that specific number and as we know, warfarin does not protect us 100% from the risk of adverse clotting. If one or several these risk markers are out of the safe range, you can still have complications.

This is the list for essential testing
Homocysteine
Fibrinogen
Ferritin
High Sensitivity or Cardiac C-reactive protein
Hemoglobin A1C
Lipoprotein (a)
Interleukin – 6
Oxidized LDL

Elevated homocysteine, above all, is a very important marker. Everyone should read about and understand the role that elevated homocysteine plays as this is a serious influence. Many past posts on homocysteine have been offered. The Internet is loaded with information… specific reference would be the book by Kilmer McCully, MD… The Homocysteine Revolution.
Start here with this link – 2 part report plus others
[www.spacedoc.com]

Refer to the original post describing these marker tests.

Red Flags to Beat the Odds
PREDICTING YOUR RISK FOR HEART ATTACK OR STROKE –THE SILENT SYMPTOMS
[www.afibbers.net]

Interleukin is not on that post… it’s an important measurement to rule out inflammation.

Integrative Cardiologist Stephen Sinatra says:
Interleukin-6 is important because it stimulates the liver to produce CRP. And, in addition to heart disease, we are learning that this cytokine has a strong association with asthma (asthma is the result of airways swelling and constricting, so it makes sense that an inflammatory agent is behind the curtains here as well). The Iowa 65+ Rural Health Study demonstrated that elevations of interleukin-6 and CRP were associated with increased risk of both heart disease and general mortality in healthy older people.
I’m convinced that interleukin-6 may be an even better marker for inflammation than CRP because these “precursor” levels rise earlier. Therefore you should ask your doctor to conduct an interleukin-6 test.
Source: [www.afibbers.org]

By knowing results in each category, we are in a better position to lower the risk of having an adverse clotting event regardless of whether we have arrhythmia. It just makes good sense to know what we need to improve or change.

More recently, Meridian Valley Labs now offers a newer test for hyperviscosity…
Read more here: [meridianvalleylab.com]

Shannon’s recent stroke as a result of clot formation following his LARIAT procedure reopens topic on the need for all of us to reassess our risk factors. Shannon has always been diligent in keeping all his numbers optimized and yet even with the best of the nattokinase product (Cardiokinase) and other supplements, his blood still had the tendency for clotting in that special area of the isolated LAA.

This is an awareness lesson for all of us and a reminder to get the basic tests done so we know if we have areas that need attention.

Jackie

I have a small LA - it was 2.8 cm last time it was measured. Yet I still had a mini-stroke 10 weeks ago!