Atrial fibrosis serves as a critical nexus between atrial arrhythmias and ischaemic stroke, particularly in patients with embolic stroke of undetermined source, independent of atrial fibrillation.
Atrial fibrosis, measurable by LGE-MRI, represents an important structural substrate linking atrial disease to ischemic stroke risk in both AF and ESUS patients.
Atrial fibrosis is an important component of the arrhythmic substrate in AF. Evidence suggests that atrial fibrosis also plays a role in increasing the risk of stroke in patients with the arrhythmia. Patients with embolic stroke of undetermined source (ESUS), who are suspected to have AF but are rarely shown to have it, frequently demonstrate evidence of atrial fibrosis; measured using late-gadolinium enhancement MRI, this manifests as atrial remodelling encompassing structural, functional and electrical properties. In this review, the authors discuss the available evidence linking atrial disease, including fibrosis, with the risk of ischaemic stroke in AF, as well as in the ESUS population, in whom it has been linked to recurrent stroke and new-onset AF. They also discuss the implications of this association on future research that may elucidate the mechanism of stroke and stroke prevention strategies in the AF and ESUS populations.
Mahnkopf et al. (Wed,) conducted a review in Atrial Fibrillation and Ischaemic Stroke. Atrial fibrosis serves as a critical nexus between atrial arrhythmias and ischaemic stroke, particularly in patients with embolic stroke of undetermined source, independent of atrial fibrillation.
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