Platelet Activation After Radiofrequency Ablation in Atrial Fibrillation
Is There Any Clinical Implication?
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population and in patients undergoing cardiac surgery.1 AF is a self-perpetuating arrhythmia that is facilitated by structural and functional changes elicited by atrial high-rate activity. The shortening of the atrial effective refractory period is the earliest functional change that characterizes atrial remodeling.2 As the prevalence of AF increases with advancing age, its social impact is becoming very relevant because of the associated high risk of cardiovascular events and increased morbidity and mortality. AF is complicated by stroke of thromboembolic origin, which is thought to stem from thrombus formation, generated in the left atrial appendage with ensuing embolism in the cerebral circulation. However, AF patients may also experience cardiovascular events that occur as a consequence of the atherosclerotic disease. Thus, AF is typically associated with different risk factors of atherothrombosis, including hypertension, diabetes mellitus, and dyslipidemia and with systemic signs of atherosclerosis. This has been documented in the thoracic aorta and, more recently, in the peripheral circulation.1
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Regarding this we have recently observed that patients with AF have ≈20% prevalence of low (<0.9) ankle/brachial index, which is a marker of systemic atherosclerosis, and it is associated with an enhanced risk of ischemic stroke and myocardial infarction.3 These findings likely account for the coexistence of ischemic stroke of thromboembolic and atherosclerotic origin and for a rate of coronary heart disease that is almost similar to the rate of ischemic stroke.3 Hence, lowering the negative clinical impact of AF, particularly in elderly patients, represents an important goal for the Western countries whose aging population is rapidly growing. Clinically relevant advantages have been achieved by oral vitamin K antagonists, which reduce by >60% the risk of systemic thromboembolism and, more recently, by novel …