Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.

Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.

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© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest: G.Y.H.L.: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos. No fees are received personally. M.P.: National leader of the AFFIRMO project on multi-morbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871; M.M.: Consultant for Boston Scientific, Biosense Webster, Abbott, Medtronic, Siemens Novartis, Janssen, Boehringer Ingelheim, Pfizer, and Sentreheart/Atricure and has equity in EPD-Philips (divested) and NewPace Ltd. T.P. and I.S.: None. H.F.T.: Consultant and speaker fee and research grant from for Abbott, BMS/Pfizer; Bayer; Boehringer Ingelheim; Boston Scientific, Daiichi-Sankyo; Medtronic and Sanofi. A.G.: EU Grant Horizon 2020 MAESTRIA Consortium; grant number 965286. Speaker fees from Abbott, Astra Zeneca, Bayer Health Care, Berlin Chemie, Biotronik, Boehringer Ingelheim, BMS/Pfizer, Boston Scientific, Daiichi-Sankyo, Medtronic, Omeicos, and Sanofi-Aventis. A.J.C.: Personal fees from Sanofi, Abbott, Boston Scientific, and Medtronic; Bayer, Daiichi Sankyo, Pfizer/BMS, Anthos, Menarini, Acesion, InCarda, Milestone, Arca, and Johnson and Johnson. C.B.-L.: Speaker’s and consultant’s fees from Bayer, Medtronic, CathPrint, Organon, Sanofi Aventis, Boston Sci, Jonson& Jonson, Abbotts, and Philips. D.G.: PI for institutional research grants from Boston Scientific and Medtronic. G.B.: Speaker’s fees of small amount from Bayer, Boehringer, Boston, Daiichi-Sankyo, Janssen, and Sanofi.