A stroke can be a very devastating event. The sudden loss of movement on one side of the body; the loss of sensation; and the change in speech, balance, or vision is all disorienting in more than one sense.

Everyone knows of someone who has had a stroke. Most recently we saw Freddy McGreggor on the stage of Sumfest showing the outcome of his stroke, sitting to sing and unable to move his left side. How can we prevent the same from happening to us?

Seventy per cent of strokes are related to uncontrolled hypertension. More than 40 per cent of Jamaicans have high blood pressure, less than 30 per cent of them are controlled. Imagine if we got that up to 90 per cent, how many strokes could be prevented. Another 20 per cent of strokes, one in every five, are related to an irregular heart rhythm called atrial fibrillation (AF). This is abnormal electrical activity in the upper chambers of the heart, called the atrium, causing it to shake rather than contract. Without this contraction, blood settles in a pocket called the left atrial appendage (LAA) where the blood forms clots. If one of these clots gets loose, it can travel to the brain, blocking the blood supply to a section and a stroke occurs. For example, if the clot blocks the blood vessel that supplies the part of the brain responsible for moving your left side, then the stroke presents as weakness or paralysis of the left side.

Atrial fibrillation is also responsible for causing heart failure, dementia, and episodes of heart racing which can cause a person to black out. Appropriate management of AF can help to reduce the incidence of a stroke. Proper management of AF is, therefore, a priority in preventing either a first stroke or subsequent strokes.

The first step is the detection of AF. Many people with AF do not know that they have it. It can be intermittent/paroxysmal or permanent. Strokes also present differently from person to person with some people being asymptomatic when their heart goes into AF, and others having feelings of weakness, palpitations, feeling faint, and shortness of breath. The only sure way to diagnose AF is by doing an ECG. As the condition may be intermittent, a regular ECG may miss the AF. Where the suspicion is high, long-term monitoring is required. In these cases a small device called a loop recorder is implanted, which can monitor the heart rhythm for up to 18 months. Anyone over the age of 60 years who has had a stroke, should have a loop recorder implanted to rule out AF.

Once diagnosed with AF, the doctor will assess your risk of clot formation and may start you on an anticoagulant (blood thinner) to prevent the formation of a clot and reduce your risk of having a stroke. A better therapy, however, is to prevent the patient from going into AF in the first place. Paroxysmal atrial fibrillation (PAF) can be treated with a therapy called cryo-ablation. This is a minimally invasive procedure in which a special catheter is passed into the left atrium via a vein in the groin and applies “cold burning” of -70 Celsius throughout the atrium. This will stop the patient from going into AF and reduce their risk of having a first stroke or a second stroke, heart failure, and the risk of dementia.

If you have had a stroke, you should be assessed to see if you have atrial fibrillation and if cryo-ablation is suitable for you.

Cryo-ablation is only available at Partners Interventional Centre of Jamaica, second floor of Medical Associates Hospital, and is part of our comprehensive stroke prevention programme. Come in for an assessment today and help us make multiple strokes a thing of the past.

Dr Victor Elliot is a consultant interventional cardiologist and managing director at Partners Interventional Centre of Jamaica.