A stressful part of living with atrial fibrillation (AFib) is having an increased risk of stroke. “I had a mini stroke this past September, and the ER doctors thought the cause was my AFib,” one MyHeartDiseaseTeam member said. Another replied, “I have AFib and high blood pressure. I had a minor stroke after a procedure.”

AFib is a form of irregular heartbeat that affects approximately 5 million people in the United States. While AFib is known to increase the risk of stroke, many people can reduce their stroke risk while living with the condition.

“I had a mini stroke this past September, and the ER doctors thought the cause was my AFib.”

— A MyHeartDiseaseTeam member

Read on to discover what causes the higher risk and how you may be able to reduce risk through treatment options and lifestyle changes.

The Risk of Stroke With AFib

The risk of stroke among people with AFib is about five times greater than that of the general population.

AFib is specifically linked with a type of stroke called ischemic stroke, which is caused by an obstruction of blood flow to the brain due to a blood clot. Irregular heartbeat from AFib causes inefficiencies in the pumping of blood. This can result in blood pooling in the heart and cause a blood clot. Blood clots that form in the left atrium of the heart can dislodge, travel to the brain, and cause a stroke.

Your cardiologist may use specific scoring systems to evaluate your risk of ischemic stroke.

The risk of stroke among people with AFib is about five times greater than that of the general population.

The CHA2DS2-VASc Score

Many healthcare providers use what’s called a CHA2DS2-VASc score to evaluate the risk of stroke with AFib. The term “CHA2DS2-VASc” stands for the conditions that affect risk: congestive heart failure, hypertension (high blood pressure), age, diabetes, stroke, vascular disease, and sex. Points are assigned to each risk factor. A higher point total indicates a higher risk of stroke:

• Congestive heart failure — 1 point
• Hypertension — 1 point
• Age 75 or older — 2 points
• Age 64 to 74 — 1 point
• Female — 1 point
• Diabetes — 1 point
• History of stroke or ministroke — 2 points
• History of vascular disease — 1 point

Reducing the Risk of Stroke

You may be able to reduce your risk of stroke with AFib with medication, surgery, and lifestyle changes.

Blood Thinners

Blood thinner drugs, also called anticoagulants, prevent blood from clotting and can reduce the risk of stroke in people with AFib. But some blood thinners may increase the risk of bleeding from injury and internal bleeding, including intracranial hemorrhage (bleeding under the skull), which can be life-threatening.

While blood thinners lower the risk of stroke, they may have negative interactions with other medications and foods.

A newer class of blood thinners — direct oral anticoagulants (DOACs) — has been shown to have less risk of intracranial hemorrhage, gastrointestinal bleeding, and other forms of bleeding.

Invasive and Surgical Procedures

AFib is caused by problems in the heart’s electrical system, where the signals for heartbeats don’t work properly. Invasive and surgical procedures can block these faulty signals and restore a regular heartbeat.

Ablation

Ablation, or catheter ablation, is a minimally invasive procedure. During ablation, a small tube (catheter) is inserted into a blood vessel in the groin to reach the heart. A tiny device uses heat (radiofrequency) or freezing (cryoablation) or short electrical pulses (PFA — pulsed field ablation) to create scars. These scars disable areas of the heart muscle that may send abnormal signals.

Like all invasive procedures, ablation comes with some risks. These include infection, damage to blood vessels or the heart, blood clots, and radiation exposure.

Maze Surgery

The maze procedure is a more elaborate and invasive form of ablation done during open-heart surgery. It’s also known as the Cox maze procedure. The procedure is usually only done when someone with AFib needs another form of invasive cardiovascular surgery, such as coronary bypass or heart valve surgery

In one study, the maze procedure had a 77 percent success rate after 10 years. It’s considered a highly effective treatment for AFib when another heart surgery is needed. However, it carries risks associated with open-heart surgery and general anesthesia. These include infection, organ damage, stroke, and life-threatening complications.

Left Atrial Appendage Occlusion

The Left Atrial Appendage Occlusion device, or LAAO, is a tiny pouch implanted in the heart to trap blood clots that may form in the left atrial appendage. The device may be suitable for people with AFib in the following groups:

• Those whose doctors recommend an oral anticoagulant (OAC) to manage their higher risk of stroke
• Those who can take OACs for short-term periods
• Those who want nondrug alternatives to OACs for valid reasons

The LAAO is considered as effective as some blood thinners, and it may be an option for people who can’t take blood thinners for long periods. The device is inserted through a catheter in a vein near the groin. Risks include misplacement of the device, a buildup of blood in the heart, and stroke.

A Healthy Lifestyle

Lifestyle changes can help prevent or reduce incidents of AFib and the risk of stroke. Some of the most effective lifestyle changes for AFib include:

• Quitting smoking
• Avoiding excessive alcohol consumption
• Eating a heart-healthy diet
• Reducing stress or anxiety
• Maintaining physical activity, like walking or gardening

Maintaining Your AFib Treatment Plan

Stick to your treatment plan for AFib to help reduce your risk of stroke. Your treatment plan may include oral medications that you take once or more per day. In addition to blood thinners, you may be prescribed anti-arrhythmic medications. You may also be prescribed other types of medications like beta-blockers or calcium channel blockers.

It’s important to stick to medication schedules and discuss any concerns with your healthcare team. Talk to your cardiologist about surgical procedures, and be sure you understand your options for treating AFib and reducing your risk of stroke.

Your healthcare team can refer you to other practitioners who may be helpful in managing AFib helping develop a stroke prevention strategy. This may include nutritionists, physical therapists, or psychotherapists.

Recognizing the Signs of Stroke

It’s important for you and your loved ones to recognize the warning signs of a stroke so you can get immediate medical attention if you need it. You can remember the warning signs of a stroke using the acronym FAST:

• Face drooping — One side of the face will droop or become numb.
• Arm weakness — One arm may become numb or weak.
• Speech difficulty — Speech will be slurred or difficult to understand, or speaking may become impossible.
• Time to call 911 — If any of these warning signs occur, even if they go away, call 911 or emergency services immediately.

Join the Conversation

On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.

What steps are you and your cardiology team taking to reduce your increased stroke risk and improve your overall heart health? Let others know in the comments below.