Is It Time to Incorporate the Left Atrial Size to the Current Stroke Risk Scoring Systems for Atrial Fibrillation?

Primary care physicians and cardiologists rely on risk scoring systems, which consist of a number of clinical variables used together, to predict stroke risk in patients with atrial fibrillation (AF). Ultimately, this helps in determining the need for anticoagulation. Left atrial size is not used in any stroke risk scoring system to stratify patients at risk for cardioembolic stroke. Throughout the literature, there is much debate surrounding the use of left atrial size as an additional risk factor for stroke in patients with and without AF. This review summarizes the stroke risk scoring systems in the currently available literature and the increasing risk of stroke associated with left atrial size. In conclusion, the authors propose the consideration of a tool to incorporate both the best available stroke risk scoring systems and the left atrial size, for a better risk assessment and management of AF.