Atrial fibrillation and stroke. Revisiting the dilemmas.

A trial fibrillation is a common cardiac dysrhythmia / \ of the elderly, and stroke is its most devastating JL ^ complication. Six years ago in Stroke, we discussed controversies surrounding the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Since then, six recent randomized trials have changed the approach to stroke prevention for AF patients.Above all else, the randomized trials have confirmed the magnitude of the problem: AF raises the risk of stroke in more than 1.5 million Americans to a degree approaching that which follows transient ischemic attack (TLA). The rate of ischemic stroke among people with AF averages 5%/y, approximately six times that of people without AF.-Additionally, considering TTAs (often causing radiographic evidence of brain infarction) and clinically occult "silent" strokes detected radiographicalry, the rate of brain ischemia accompanying nonvalvular AF exceeds 7%/y.-