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Why Does Atrial Fibrillation Increase Risk of Stroke?

Simply put, we know Atrial fibrillation (AFib) as an irregular, often rapid heartbeat. One of the most important things to learn is that AFib increases the risk of stroke. Understanding this and learning a bit about why this is the case can help to ease fear. It can also aid in simplifying treatment decisions: such as taking a blood thinner. 

In normal sinus rhythm, the two upper chambers of the heart (the atria) contract and push blood in a coordinated way. When the heart is in AFib, the two upper chambers quiver rather than contracting effectively. Because the atria aren’t squeezing properly, the flow of blood is interrupted. This often leads to a “pooling effect”, especially in a small pouch called the left atrial appendage. This is important because when blood sits still, the formation of a blood clot becomes more likely which in turn unlocks the possibility of a stroke. 

So if a clot forms in the heart, it can travel through the bloodstream and block an artery in the brain–causing a stroke. Now, this does not mean that everyone with AFib will develop a clot, but AFib does significantly increase the risk and this is why stroke prevention is a major focus of AFib treatment and management.

What is the CHA₂DS₂‑VASc score my doctor mentioned?

During a visit with a doctor (likely an electrophysiologist: the specialist that deals with arrhythmias) you may hear the term CHA₂DS₂‑VASc score. This is a scoring tool that doctors often use to estimate a person’s stroke risk and help inform treatment decisions. Each letter simply represents a risk factor: the higher the score, the higher the stroke risk. The score helps to guide decisions and help to make sure patients get the protection they need in order to stay safe from stroke risk. The following infographic helps to clearly outline the components. 

Do I really need a blood thinner?

This is a question that often arises from conversation regarding AFib and stroke risk. It is important to note that Blood thinners (also called anticoagulants) do not treat or fix AFib. What they do is make it much harder for dangerous clots to form, therefore reducing stroke risk. 

Nerves in regard to starting a blood thinner are absolutely normal and usually stem from concerns regarding bleeding risk. This is something that your provider will take into consideration when advising treatment. This is an individualized decision aimed at increasing safety and protection. Your doctor will consider your  CHA₂DS₂‑VASc score as well as other variables including your medical history, lifestyle and fall risk to recommend the safest plan.