Complexities in the Atrial Fibrillation-Stroke Relationship: Improving Comprehension of Temporal Discordance, Magnitude Synergism, and Subclinical Atrial Fibrillation -- Three Sources of Consternation for Physicians Who Care for Patients with Atrial Fibrillation.

That clinically-documented atrial fibrillation (AF) in association with a variety of elevated clinical/laboratory risk markers is associated with an increased risk of stroke is well known -- regardless of whether the AF is paroxysmal, persistent, or permanent. Moreover, data is accumulating to suggest that the absolute rate of stroke should be expectedly higher with a greater burden of AF and greater degree of comorbid contributors. Relatedly, stroke prevention with chronic oral anticoagulation (OAC) is recommended for AF patients with appropriate risk markers by all major medical, cardiologic, and surgical guideline-writing organizations. However, at least two major clinical concerns about the above AF-stroke statements remain. First, if AF is related to stroke, why then is there not a consistent temporal relationship between a stroke and AF? Second, is there importance to and what should we do about device-detected AF (so-called subclinical AF [SCAF]) in the absence of clinically-recognized AF? This paper is designed to enhance the understanding of these issues and reduce the consternation of physicians who care for patients with AF with respect to them.