The heart is a complex organ made of muscle that is powered by electrical impulses. Every heart comes equipped with what cardiac electrophysiologists (cardiologists who specialize in diagnosing and treating problems with the heart’s electrical system) like to call a ‘biological pacemaker,’ which is the heart’s natural electrical system (also known as the sinus node). It’s designed to send signals in organized contractions to keep blood pumping where it needs to go.

WakeMed Heart & Vascular electrophysiologist Dr. Kevin Manocha explains, “When the heart’s electrical system doesn’t work properly, the impulses may be too fast, too slow or erratic, and that’s known as an arrhythmia. And, while arrhythmias are quite common and can generally be treated, it’s very important to be aware that many are linked to a higher risk of stroke.”

The Risk of Stroke, Explained

During a normal heartbeat, blood pumps in and out of the heart’s four chambers (atria and ventricles) in a seamless, perfectly timed manner. The right atrium takes blood from the veins and pumps it to the right ventricle. The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle. This pattern is orchestrated by the heart’s electrical system.

Because an arrhythmia changes the way your heart beats, the ventricles don’t always have enough time to fill and empty blood with each heartbeat. Blood flow is often stalled or interrupted by the untimely rhythm — which can leave some blood sitting in one of the heart’s chambers. Any time blood isn’t moving, you increase your risk of a blood clot. When a blood clot leaves the heart, it can travel to the small arteries in the brain — leading to an interruption in blood flow that can cause a stroke.

Which Arrhythmias Lead to Increased Risk of Stroke?

It’s important to note that not all arrhythmias are associated with an increased stroke risk. Here’s a quick overview of the most common types that are:

• Atrial Fibrillation (AFib) is a chaotic and often very rapid heart rhythm. It’s the most common type of arrhythmia — and the one most closely linked to stroke. In fact, nearly 15 to 20 percent of all strokes occur in patients with AFib, which is associated with a fivefold increased risk for stroke.
• Atrial flutter is a consistent, fast heartbeat that begins in the upper chambers of the heart. Because the contractions are too frequent, the heart chambers can’t move blood as quickly through the upper chambers, which could lead to the formation of blood clots that lead to stroke.
• Junctional bradycardia is a slow heart rate that originates in the AV node, a specific area of the heart’s electrical system. A 2016 study published in BMC Neurology indicated that this type of arrhythmia may increase stroke risk in certain patients.
• Sick sinus syndrome refers to several rhythm problems in the SA node of the electrical system. A 2020 research study published in Stroke journal concluded that patients with these arrhythmias are
  at a greater risk of stroke.

Stroke Prevention for Patients with Arrhythmia

For patients with arrhythmias linked to an increased risk of stroke, there are multiple ways to reduce that risk. While the most appropriate option(s) for each patient should be discussed with a cardiologist and/or electrophysiologist, here is a brief overview of the most common treatments.

Medication therapy:

For patients with arrhythmia, your cardiologist will carefully evaluate your risk for stroke based on your age and health history. In many cases, patients will be prescribed anticoagulant therapy (blood thinners) to reduce the risk of blood clots. Rhythm control: In all arrhythmia patients, it’s important to take steps toward achieving normal rhythm — which can help reduce the risk of stroke. For some patients, this could mean addressing underlying risk factors that could contribute to the arrhythmia, such as excessive alcohol use, obesity, sleep apnea and/or diabetes. For some patients, there are a number of procedural options to help achieve and/or maintain a normal rhythm, such as cardioversion and ablation therapy, among others.

Left atrial appendage closure:

For patients who aren’t a good candidate or aren’t interested in taking a blood thinner, a left atrial appendage closure (LAAC) procedure can help reduce the risk of stroke. This procedure involves either removing or closing off a small sac in the muscle wall of your left atrium, which is an area of the heart where blood clots often form in patients with atrial fibrillation. There are multiple options for LAAC, including those that use Lariat, Watchman and Amulet
devices.

“Being diagnosed with an arrhythmia can be so overwhelming that sometimes, the risk of stroke can be overshadowed by managing the condition,” explains Dr. Manocha. “It’s important that patients and their loved ones understand the risk for stroke and become familiar with the signs and symptoms because acting fast can save critical brain tissue.”

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About WakeMed Heart and Vascular

WakeMed Heart & Vascular physicians bring together expert cardiovascular, thoracic and vascular surgeons who are dedicated to delivering the highest level of cardiovascular care in Raleigh, Apex, Cary, Fuquay-Varina, Garner and Clayton, N.C. For decades, these physicians have chosen to bring their talent and expertise to WakeMed for its reputation for excellence in cardiovascular care and commitment to providing the most exceptional patient experience.

About WakeMed Atrial Fibrillation Center

If you have a new diagnosis of Atrial Fibrillation (AFib) or an existing diagnosis of AFib and need additional support, WakeMed Heart & Vascular’s Atrial Fibrillation Center is here for you.

Patients with AFib often have multiple complications related to their heart that further increases their chance of having a stroke or developing heart failure. Our AFib Center brings together a multidisciplinary team to provide the care and resources you need to help you understand and manage your condition. Call 919-350-AFIB (2342) for more information.

This article is a reprint from Heart to Heart Magazine. Subscribe today for your free copy.