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Reiffel - Atrial Fibrillation and Stroke: Epidemiology - Figure 16

Possible Reasons for Persistence

There are other possible reasons for the persistence of thrombotic risk in patients who have risk factors for stroke and who have had AFib but are currently in sinus rhythm – or, put another way, although these patients are in sinus rhythm, their risk for stroke does not return to normal. There could be

recurrent asymptomatic AFib;
incomplete reverse atrial remodeling, with the resultant flow impairment
incomplete remodeling of the endothelium
negative atrial inotropic effects of the AFib drug used or of an attempted ablative therapy procedure.

There are also concomitant pro-embolic sources, so physicians should not believe that restoration of sinus rhythm removes the risk for stroke in a patient who has had atrial fibrillation – this is one of many misunderstood concepts in AFib management.

Reiffel JA. Am J Med 2013; 126: 00-00.