Why I don't believe that AFib causes strokes

hi guys um my name is Sanjay Gupta I am a consultant cardiologist in New York and today I wanted to do a video which is titled why I don't believe that atrial fibrillation causes strokes now this is a very provocative title and I will try and explain my reason for doing this video and also then try and tell you why I really don't believe that atrial fibrillation causes strokes okay a few months ago I put a video out on the subject of ablation ah and that received quite a lot of criticism from people on various sites even on the video there was a bit of criticism because they said oh well you know I said in this video I said well if even if you have an ablation you shouldn't stop your anticoagulants because because I believe that the risk of stroke persists even if you have an ablation and your atrial fibrillation goes away and a lot of people wrote back and said oh he doesn't know what he's talking about you know my my my doctors stopped my anticoagulants etc etc etc so the first thing so that that and I want to try and prove why I think that I think that people should not stop their anticoagulants even after they've had a successful ablation let me talk you through this all right number one there is no doubt that people who have atrial fibrillation are more likely to have strokes the risk of stroke goes up five of times in people who have had atrial fibrillation but we have made this assumption that because people who have atrial fibrillation have more strokes that it is the atrial fibrillation which is causing the strokes okay and that is why people say well okay so if I get rid of the atrial fibrillation that I won't have strokes and therefore they say well if I could be cured from atrial fibrillation okay then that means I'm cured you know I don't have to worry about these things I don't need to worry about this and what I want to tell you is that I don't really believe that atrial fibrillation causes the strokes in the first place and therefore even if you get rid of the atrial fibrillation I don't believe it really makes a huge difference to your stroke risk okay so here is the deal number one in let me tell you let me just get this paper out that I was reading um here we go okay there was a very interesting paper published there's lots of reasons okay but let me talk you through these here we go there was a very interesting paper published in the New England Journal of Medicine in 1987 okay the lead author is Steven L Kopecky kop II CKY you can find that on PubMed com from 1950 to 1980 they recruited three thousand six hundred and twenty three patients who had atrial fibrillation the special thing about these patients were that they were young they were under the age of 16 and they had no other conditions ie they only had atrial fibrillation maybe they had it once maybe they had it a few times maybe they had it all the time but they did not have high blood pressure they did not have diabetes they did not have heart failure they did not have hot disease and they were young okay and these guys then followed these patients up for 15 years and at the end of 15 years they calculated that only 1.3 percent of the original number of patients had had a stroke so they concluded that the risk of stroke was incredibly low in these people and therefore there was no merit in giving them anticoagulants because the risk of stroke was so incredibly low these are all patients who had had some atrial fibrillation remember that now then there was a very interesting study in the Journal of American College of Cardiology in 2007 the lead author is Mia Sokka my a sa ka okay again available on PubMed to read here they said okay let us follow up patients who have atrial fibrillation but you also have comorbidities I who are older so the mean age was 73 remember the previous study everyone was young here people were about around about the age of 73 they had other comorbidities like diabetes high blood pressure heart failure etc and they found 4618 patients okay and by the end of the follow-up period of five and a half years between five and ten years but the mean follow for the past five and a half years they found that 3085 of the 4618 patients had died okay and in these people they found that it was an incredible these patients had a very high risk of strokes very high risk of death very high risk of complications so the question therefore is that if you have atrial fibrillation and if atrial fibrillation causes strokes why the discrepancy in one group who is young and has no other comorbidities but has atrial fibrillation and they all live for a very long time without strokes and then you have another group and who have exactly the same condition but who are older who have other comorbidities like diabetes high blood pressure and why do they all do so badly with such a high risk of stroke so how can it be the atrial fibrillation which is causing the stroke when you have atrial fibrillation in both groups and there is such a dis crepitus II in their overall prognosis so that's the first point okay number two here's another very interesting paper that I came across let me just find it sorry I'm just going to find this other paper here which is here we go here's another really interesting paper okay now it was published in Euro pace 2012 the lead author is Shan Mugen sha n mu G am making and what they did was this they found patients who had heart failure okay and these patients had had a special kind of pacemaker put in called a biventricular pacemaker because that can sometimes make the hot failure symptoms better the advantage of having such a device in is that it will pick up if you develop any atrial fibrillation thank you and so what they did was they use this device to pick up silent atrial fibrillation or any atrial fibrillation that may be occurring in these patients and they found that there were patients there were patients who had atrial fibrillation and there were patients who had stroke okay but the majority of patients 73% of those patients who had had it who subsequently went and had a stroke did not have any temporal relationship between episodes of atrial fibrillation i yes they were getting atrial fibrillation and yes they had the stroke that the stroke did not happen when they were having the atrial fibrillation okay that in 73 percent of type those patients there was no relationship between the time when they were in the atrial fibrillation and the time when they had the stroke and therefore that gives you more insight into the fact that maybe the atrial fibrillation is not the cause of the stroke because if it were why wouldn't they be happening at the same time okay number two number three if you go to any cardiologist with atrial fibrillation the first thing they try and do is they try and work out your risk of stroke and they use something called the chads2 vask system to calculate your risk of stroke okay now nowhere in the chads2 vast scoring system does it say that you have to be nature of fibrillation being in atrial fibrillation is not considered a risk factor for developing stroke yes it is used in people who have atrial fibrillation but you may have had atrial fibrillation you know seven months ago and you may now be back in a normal heart rhythm which some people do of which some people are in and when you go to have your risks calculated nowhere doesn't say oh well your risk goes up because you are now in atrial fibrillation they say well you were in atrial fibrillation so many months ago I know you're in sinus rhythm now you're not even in a chor population but your risk of stroke is calculated by whether you have your comorbidities whether you're older whether you're above the age of 65 whether you have diabetes whether you have high blood pressure whether you have a heart disease or heart failure those are the things that increase your risk of stroke atrial fibrillation itself is not one of those one of those variables that gives you a point or increases your risk of stroke and that is why those people who score very low okay but have atrial fibrillation are not given anticoagulants and those people who score highly are given anticoagulants well if the atrial fibrillation was causing the stroke and you've got patients who have atrial fibrillation but otherwise don't have any other comorbidities why are they not being given anticoagulants they're not being in Atlantic Wegmans because the atrial fibrillation itself is probably not the cause of stroke it is the company it keeps the company being diabetes high blood pressure old age etc etc etc and that's another important point to bear in mind and therefore those people who said to me well my doctor stopped my anticoagulants after my ablation the reason those anticoagulants were stopped was probably because you didn't need them in the first place you didn't need the anticoagulants in the first place you were only put on the antiquarians for the purposes of the ablation okay the ablation does not mean you stopped the anticoagulants the ablation has nothing to do with the antiquary you either need anticoagulants or you do not need anticoagulants if you don't need anticoagulants but then go for an ablation sometimes they give you an antique value just to cover you during that period because they're doing things to your heart but otherwise they stop it so those people say those people who were saying oh well you know you don't know anything how can you say that my doctor stock multi-wavelength I've never needed them well you probably didn't need them for the atrial fibrillation anyway you would given those antique likings because you were going to have a procedure performed on your heart okay but those people who have a high chance to vasp score even after they have had a successful ablation are left on their anticoagulants and all the major guidelines say this and pretty well much every electrophysiologist will say that if you risk before your ablation was high it doesn't matter whether the ablation is successful and we've gotten rid of the air for naught you still continue on the anticoagulant okay one last interesting point and that was a study which was done in patients who have pacemakers and who had never had AF so there is the reason they was done in people who have pacemakers etc was because then you can be absolutely confident that they've never had atrial fibrillation because the pacemaker will detect any atrial fibrillation okay so they didn't want to contaminate the sample by people who had this silent AF okay so you you you you know you are sure they've not had any atrial fibrillation and they calculated their chads2 Vasc scores they calculated their age their diabetes whether they had high blood pressure etc and they followed these people up and naturally these people who had never had a job revelation but who had a high chance to vasp school had the same risk of having events like strokes as those people who had atrial fibrillation as well and therefore again this makes us think that maybe atrial fibrillation is not the cause of the stroke maybe atrial fibrillation is simply a marker and tells us who is at a higher risk of stroke because of all the other comorbidities that they carry and this is why when you go for things like an ablation etc you know you are not really when you go and you think I'm a lot of people said well you know this is the only cure we can cure the atrial fibrillation what does that mean what are you saying what does ature mean if you're thinking that the true means that you're not going to have stroke you're very much mistaken your risk of stroke is based on the comorbidities that you carry the company that the atrial fibrillation keeps not on the presence or absence of atrial fibrillation okay and so let me just give you a little bit about myself I hope you found this useful if you find that you want any of the papers come on and join me on my Facebook page sorry this was the title said this is my Facebook page your cardiology at gmail.com www cardiology okay okay some people have said look you know what do you know you're not an electrophysiologist so I'm not an electrophysiologist I accept that but I do look off to patients who have atrial fibrillation and I do manage them and there's some feedback from the patients that I actually look after and that you can find on www.ilga.gov k and if you type in centric of the chair cardiologist you'll you'll get some feedback from live patients all right thank you so much or what keep the comments coming in please feel free to ask me any questions and please feel free to come and join me on my Facebook page and I hope to put some more videos out soon but I really really appreciate all the great comments I get some great feedback thank you so much

Channel: York Cardiology

Views: 155,054

Keywords: Dr Sanjay Gupta, York YO31 8LA, YO31 8LA, cardiologist, Echocardiography, atrial fibrillation, afib, AF, strokes, #hangoutsonair, Hangouts On Air, #hoa

Id: LERfUhYIXZM

Length: 15min 56sec (956 seconds)

Published: Fri Dec 09 2016