# High-Risk Aortic Plaque in Atrial Fibrillation: A Therapeutic Dilemma

## TL;DR

This paper discusses the management of atrial fibrillation in a patient with a high-risk aortic plaque, highlighting a treatment approach to prevent stroke and embolic events.

## Contribution

The paper presents a novel case report and literature review addressing the therapeutic dilemma of managing AF with high-risk aortic plaques.

## Key findings

- Anticoagulation, statin, and imaging surveillance effectively managed a patient with AF and high-risk aortic plaque.
- There is currently no consensus on treating AF combined with high-risk aortic plaques.
- Collaborative care between cardiologists and cardiothoracic surgeons can successfully manage this dual challenge.

## Abstract

Atrial fibrillation (AF), a common cardiac arrhythmia, is often accompanied by aortic plaques that are associated with an increased risk of embolic events, including stroke. Evidence-based management in this population is lacking. We present a case of a 77-year-old female with new-onset AF who was found to have a high-risk aortic plaque at the level of the ascending aorta and ostium of the right coronary artery. Definitive treatment for AF, cardioversion, high-risk aortic plaque, and cardiothoracic surgery, could not be performed due to the elevated risk of ischemic stroke and embolic complications. Based on existing literature, the cardiologist and cardiothoracic surgeon collaboratively decided to treat both conditions with anticoagulation, statin, and periodic imaging surveillance of high-risk aortic plaque. The patient was successfully managed without any thromboembolic complications despite an elevated risk. This case report provides a comprehensive literature review of managing AF with high-risk aortic plaques. It delves into the integration of anticoagulation and antiplatelet agents in the dual challenge of stroke prevention in AF and mitigating embolic risks associated with aortic plaques. To date, there has been no consensus on managing AF and high-risk aortic plaques; thus, we aim to fill this gap.