You may have heard of atrial fibrillation (a-fib), an irregular heartbeat that slows the flow of blood from the upper chambers, or atria, of the heart into the lower ventricles. This slowdown increases the risk that blood will pool and form clots, which in turn increases the risk of stroke and other heart-related conditions. In general, people with chronic a-fib are three times more likely to have a stroke than those who do not have this condition.

Surgery and Risk of A-Fib

Atrial fibrillation in patients who don’t have the condition can also occur during or after surgery (perioperative a-fib); approximately 2 out of every 300 surgical patients will experience this due to the physiological stress of the surgery. Until recently, perioperative a-fib was thought to be a temporary condition, with no long-term affects on patients’ health.

But a recent study of more than 1.7 million patients in the Journal of the American Medical Association (JAMA) found that perioperative a-fib is associated with a higher long-term risk of ischemic stroke, the most common type of stroke. Ischemic stroke is the result of an obstruction, or clot, in a blood vessel that leads to the brain. Close to 800,000 strokes occur in the US annually, making it the fourth leading cause of death and the culprit behind "more serious long-term disabilities than any other disease," according to the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS).

About the Study

The JAMA researchers followed study participants for an average of about two years. They found that a-fib during or after surgery is more common in those undergoing cardiac (heart) surgery, and that surgery-related a-fib is also more common in older patients, and in those with high blood pressure, diabetes, coronary disease or heart failure.

The investigators also discovered that while cardiac patients are more likely to experience a-fib during or after surgery, these patients’ long-term risk of stroke was only slightly higher than other cardiac patients’. However, the long-term risk of stroke among non-cardiac patients who developed perioperative a-fib was more than three times greater than other non-cardiac patients.

Lowering A-Fib Patients’ Risk of Stroke

While at this point it’s unclear what you can do to lower your risk of perioperative a-fib and stroke, Hooman Kamel, MD, study author and assistant professor at Weill Cornell Medical College in New York, recommends lowering your general risk of heart disorders and stroke by following the American Heart Association’s (AHA) "Life’s Simple 7" guidelines:

  • Get active. Follow AHA’s Recommendations for Physical Activity in Adults which includes a guidelines of at least 30 minutes of moderately intensive aerobic activity at least 5 days a week, for a total of 150 minutes.
  • Lose weight. Increase aerobic activity while reducing calorie intake.
  • Eat better. Increase your consumption of fruits, vegetables and fiber; eat fish at least twice a week; reduce sodium to no more than 1,500 mg per day.
  • Reduce blood sugar. Take steps to maintain normal blood sugar to help prevent diabetes, which quadruples your risk of heart disease or stroke.
  • Control cholesterol. Avoid excessive consumption of animal products, have your cholesterol levels routinely checked and take medication prescribed by your doctor, if necessary.
  • Manage blood pressure. Maintain a healthy weight, exercise regularly, limit salt and alcohol, don’t smoke, and use medication prescribed by your doctor.
  • Stop smoking. Quit and you reduce your risk to that of a nonsmoker within a few years.

Hooman Kamel, MD, reviewed this article.


Hooman, Kamel MD. Email message to author, September 24, 2014.

Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS and Kamel H. "Perioperative Atrial Fibrillation and the Long-Term Risk of Ischemic Stroke." Journal of the American Medical Association 312, no. 6 (2014):616-22. doi: 10.1001/jama.2014.9143.

"My Life Check: Life’s Simple 7." American Heart Association/American Stroke Association. Accessed September 25, 2014. 

"Know Stroke: Know the Signs, Act in Time." National Institutes of Health/National Institute of Neurological Disorders and Stroke (NINDS). Page accessed October 7, 2014.