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Review
. 2016 Mar;47(3):895-900.
doi: 10.1161/STROKEAHA.115.012004. Epub 2016 Jan 19.

Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model

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Free PMC article
Review

Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model

Hooman Kamel et al. Stroke. .
Free PMC article

Abstract

No abstract available

Keywords: atrial cardiomyopathy; atrial cardiopathy; atrial fibrillation; cardioembolism; embolic stroke.

Figures

Figure 1
Figure 1
Updated Model of Thromboembolic Stroke. This model emphasizes the importance of systemic and atrial substrate as well as rhythm in explaining the relationship between atrial fibrillation (AF) and stroke. In this model, aging and systemic vascular risk factors cause an abnormal atrial tissue substrate, or atrial cardiopathy, that can result in AF and/or thromboembolism. Once AF develops, the dysrhythmia causes contractile dysfunction and stasis, which further increases the risk of thromboembolism. In addition, over time the dysrhythmia causes structural remodeling of the atrium, thereby worsening atrial cardiopathy and increasing the risk of thromboembolism even further. In parallel, systemic risk factors increase stroke risk via other mechanisms outside the atrium, such as large-artery atherosclerosis, ventricular systolic dysfunction, and in-situ cerebral small-vessel occlusion. Once stroke occurs, autonomic changes and post-stroke inflammation may transiently increase AF risk.

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