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Title: The Atrium and Embolic Stroke: Myopathy Not Atrial Fibrillation as the Requisite Determinant?
Austin Authors: Sajeev, Jithin K;Kalman, Jonathan M;Dewey, Helen;Cooke, Jennifer C;Teh, Andrew W 
Affiliation: Department of Neuorosciences, Eastern Health, Melbourne, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
University of Melbourne, Melbourne, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Monash University, Melbourne, Victoria, Australia
Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
Issue Date: Mar-2020
Publication information: JACC. Clinical electrophysiology 2020; 6(3): 251-261
Abstract: Atrial fibrillation (AF) is well-recognized in the pathophysiology of left atrial thrombogenesis and resultant cardioembolic stroke. Subclinical AF is believed to account for a significant proportion of embolic stroke. However, recent randomized control trials failed to demonstrate a significant benefit for oral anticoagulation, in an unselected population with embolic stroke of undetermined source. This has reinvigorated the focus on finding robust markers to identify patients at risk of cardioembolic stroke. Several nonfibrillatory atrial electrical markers, along with structural and biochemical abnormalities, have been associated with ischemic stroke, independently of AF. An increasingly complex relationship exists among vascular risk factors, atrial remodeling, and thrombogenesis. Identifying robust markers of an underlying atrial myopathy may allow for early identification of patients at risk for cardioembolic stroke. This review outlines the inconsistencies in the evidence for AF as the prerequisite for left atrial thrombogenesis and embolic stroke. It will highlight the current evidence and controversies for adverse atrial remodeling, independent from rhythm, as a plausible mechanism for left atrial thrombogenesis and ischemic stroke.
DOI: 10.1016/j.jacep.2019.12.013
Journal: JACC. Clinical electrophysiology
PubMed URL: 32192674
Type: Journal Article
Subjects: ESUS
Appears in Collections:Journal articles

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