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Kogelschatz B, Zenger B, Steinberg BA, Ranjan R, Jared Bunch T. Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review. Trends Cardiovasc Med 2024; 34:236-241. [PMID: 36702389 DOI: 10.1016/j.tcm.2023.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
The relationship between atrial fibrillation (AF) and dementia has been well described; however, recent data suggest that AF confers a greater risk for the development of early-onset dementia irrespective of clinical stroke. Numerous mechanisms have been hypothesized to explain cognitive decline in the setting of AF, including silent cerebral ischemia, cerebral hypoperfusion, and cerebral microvascular disease. Despite the emergence of data supporting the increased risk of early-onset dementia in patients with AF, the underlying mechanism remains unclear. Furthermore, the mechanism may be influenced by survival bias, genetic susceptibility, or early dysfunction of brain adaptation. Investigation into why this relationship exists could change how prevention and treatment are evaluated.
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Affiliation(s)
- Benjamin Kogelschatz
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA.
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Åkerström F, Charitakis E, Paul-Nordin A, Braunschweig F, Friberg L, Tabrizi F, Jensen-Urstad M, Drca N. Reduced dementia risk in patients with optimized anticoagulation therapy undergoing atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)02365-8. [PMID: 38604586 DOI: 10.1016/j.hrthm.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with the development of dementia, and observational studies have shown that oral anticoagulation and catheter ablation reduce dementia risk. However, such studies did not consistently report on periprocedural anticoagulation and long-term oral anticoagulation coverage, for which reason the separate effect of AF ablation on dementia risk could not be established. OBJECTIVE We evaluated the protective effect of AF ablation in a large cohort of patients who received optimized anticoagulation and compared them with patients who were managed medically. METHODS We retrospectively included 5912 consecutive patients who underwent first-time catheter ablation for AF between 2008 and 2018 and compared them with 52,681 control individuals from the Swedish Patient Register. Propensity score matching produced 2 cohorts of equal size (n = 3940) with similar baseline characteristics. Dementia diagnosis was identified by International Classification of Diseases codes from the patient register. RESULTS Most propensity score-matched patients were taking an oral anticoagulant at the start (94.5%) and end (75.0%) of the study. Mean follow-up was 4.9 ± 2.8 years. Catheter ablation was associated with lower risk for the dementia diagnosis compared with the control group (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.22-0.86; P = .017). The result was similar when including patients with a stroke diagnosis before inclusion (HR, 0.50; 95% CI, 0.28-0.89; P = .019) and after adjustment for the competing risk of death (HR, 0.41; 95% CI, 0.20-0.86; P = .018). CONCLUSION Catheter ablation of AF in patients with optimized oral anticoagulation therapy was associated with a reduction in dementia diagnosis, even after adjustment for potential confounders and for competing risk of death.
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Affiliation(s)
- Finn Åkerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.
| | - Emmanouil Charitakis
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute Danderyd Hospital, Stockholm, Sweden
| | | | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
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3
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Carneiro HA, Knight B. Does asymptomatic atrial fibrillation exist? J Cardiovasc Electrophysiol 2024; 35:522-529. [PMID: 37870151 DOI: 10.1111/jce.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Atrial fibrillation (AF) is currently defined as symptomatic by asking patients if they are aware of when they are in AF and if they feel better in sinus rhythm. However, this approach of defining AF as symptomatic and asymptomatic fails to adequately consider the adverse effects of AF in patients who are unaware of their rhythm including progression from paroxysmal to persistent AF, and the development of dementia, stroke, sinus node dysfunction, valvular regurgitation, ventricular dysfunction, and heart failure. Labeling these patients as asymptomatic falsely suggests that their AF requires less intense therapy and puts into question the notion of truly asymptomatic AF. Because focusing on patient awareness ignores other important consequences of AF, clinical endpoints that are independent of symptoms are being developed. The concept of AF burden has more recently been used as a clinical endpoint in clinical trials as a more clinically relevant endpoint compared to AF-related symptoms or time to first recurrence, but its correlation with symptoms and other clinical outcomes remains unclear. This review will explore the impact of AF on apparently asymptomatic patients, the use of AF burden as an endpoint for AF management, and potential refinements to the AF burden metric. The review is based on a presentation by the senior author during the 2023 16th annual European Cardiac Arrhythmia Society (ECAS) congress in Paris, France.
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Affiliation(s)
- Herman A Carneiro
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Bradley Knight
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois, USA
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Guo J, Liu Y, Jia J, Lu J, Wang D, Zhang J, Ding J, Zhao X. Effects of rhythm-control and rate-control strategies on cognitive function and dementia in atrial fibrillation: a systematic review and meta-analysis. Age Ageing 2024; 53:afae009. [PMID: 38369630 DOI: 10.1093/ageing/afae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Growing evidence suggests that atrial fibrillation (AF) is an independent risk factor for cognitive impairment and dementia, even in the absence of thromboembolic events and stroke. Whether rhythm-control therapy can protect cognitive function remains unclear. We aimed to evaluate the efficacy of rhythm-control strategies in patients with AF regarding cognitive function and dementia risk. METHODS We systematically searched the PubMed, Embase and Cochrane Library databases for randomised clinical trials, cohort and case-control studies evaluating the associations between rhythm-control strategies and cognitive function outcomes up to May 2023. We assessed the risk of bias using the ROBINS-I and the Cochrane risk-of-bias tool. Both fixed- and random-effects models were used to create summary estimates of risk. RESULTS We included a total of 14 studies involving 193,830 AF patients. In the pooled analysis, compared with rate-control, rhythm-control therapy was significantly associated with a lower risk of future dementia (hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.62-0.89; I2 = 62%). Among the rhythm-control strategies, AF ablation is a promising treatment that was related to significantly lower risks of overall dementia (HR 0.62; 95% CI 0.56-0.68; I2 = 42%), Alzheimer's disease (HR 0.78; 95% CI 0.66-0.92; I2 = 0%) and vascular dementia (HR 0.58; 95% CI 0.42-0.80; I2 = 31%). Pooled results also showed that compared with patients without ablation, those who underwent AF ablation had significantly greater improvement in cognitive score (standardized mean difference (SMD) 0.85; 95% CI 0.30-1.40; P = 0.005; I2 = 76%). CONCLUSIONS Rhythm-control strategies, especially ablation, are effective in protecting cognitive function, reducing dementia risk and thus improving quality of life in AF patients.
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Affiliation(s)
- Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaokun Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingjing Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Ding
- Department of Neurology, Shandong Public Health Clinical Center, Jinan, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Jaiswal V, Ang SP, Deb N, Roy P, Chauhan S, Halder A, Rajak K, Raj N, Patel N, Soni S, Habib A, Shreshtha AB, Jaiswal A, Mattumpuram J. Association Between Catheter Ablation and Dementia Among Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2024; 49:102154. [PMID: 37852556 DOI: 10.1016/j.cpcardiol.2023.102154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of Dementia. However, the association between catheter ablation (CA) in patients with atrial fibrillation and the risk of dementia is not well established, with conflicting results to date. We aimed to evaluate the association between CA patients and the risk of Dementia. We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until 10th May 2023. Hazard ratios (HR) were pooled using a random-effect model, and a P-value of < 0.05 was considered statistically significant. A total of 5 studies with 125,649 patients (30,192 in the CA group and 95,457 in the non-CA group) were included. The mean age of patients among CA and non-CA groups was comparable (58.7 vs 58.18). The most common comorbidity among CA and non-CA groups was hypertension (18.49% vs 81.51%), respectively. Pooled analysis of primary outcome showed that CA was associated with a significant reduction in the risk of Dementia (HR, 0.63 [95% CI: 0.52-0.77], P < 0.001). Similarly, pooled analysis of secondary outcomes showed that the patients with CA had a lower risk of Alzheimer's disease (HR, 0.78 [95% CI: 0.66-0.92], P < 0.001) compared with the non-CA group. However, there was no statistically significant difference in the risk of vascular dementia (HR, 0.63 [95% CI: 0.38-1.06], P = 0.08) between both groups of patients. Our study suggested that catheter ablation reduced the risk of dementia and Alzheimer's disease compared to the nonablation group of patients.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiology Research, Larkin Community Hospital, South Miami, FL, USA; JCCR Cardiology Research, Varanasi, India
| | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ
| | - Novonil Deb
- North Bengal Medical College and Hospital, India
| | - Poulami Roy
- North Bengal Medical College and Hospital, India
| | | | - Anupam Halder
- Department of Internal Medicine, UPMC Harrisburg, Harrisburg, PA
| | - Kripa Rajak
- Department of Internal Medicine, UPMC Harrisburg, Harrisburg, PA
| | - Nishchita Raj
- Department of Psychiatry, Santosh Medical College and Hospital, Ghaziabad
| | - Nirmit Patel
- Department of Cardiology Research, Larkin Community Hospital, South Miami, FL, USA; JCCR Cardiology Research, Varanasi, India
| | - Siddharath Soni
- Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India
| | | | | | - Akash Jaiswal
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Jishanth Mattumpuram
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY.
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Harrison SL, Buckley BJR, Austin P, Lane DA, Lip GYH. Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation. J Am Geriatr Soc 2023; 71:3357-3366. [PMID: 37609682 DOI: 10.1111/jgs.18538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co-morbidity status, and oral anticoagulant use. METHODS The research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity-score matched cohorts. RESULTS After propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co-morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45-0.61). The catheter ablation cohort also had a lower risk of all-cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55-0.61). These associations remained in subgroup analyses in individuals aged 65-79 years, ≥80 years, males, females, participants who received OACs during follow-up, participants with paroxysmal and non-paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. CONCLUSION The observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient-centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required.
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Affiliation(s)
- Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Li GY, Chen YY, Lin YJ, Chien KL, Hsieh YC, Chung FP, Lo LW, Chang SL, Chao TF, Hu YF, Lin CY, Chen SA. Ablation of atrial fibrillation and dementia risk reduction during long-term follow-up: a nationwide population-based study. Europace 2023; 25:euad109. [PMID: 37097046 PMCID: PMC10228604 DOI: 10.1093/europace/euad109] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
AIMS This study investigated the epidemiological characteristics of new-onset dementia in patients with atrial fibrillation (AF) and the association of catheter ablation with different subtypes of dementia. METHODS AND RESULTS We conducted a population-based, retrospective cohort study using data from the Taiwan National Health Insurance Research Database. In total, 136 774 patients without a history of dementia were selected after 1:1 propensity score matching based on age (with AF vs. without AF). A competing risk model was used to investigate the three subtypes of dementia: Alzheimer's disease, vascular dementia, and other/mixed dementia. Inverse probability of treatment weighting (IPTW) was performed to minimize the impact on dementia risk due to the imbalanced baseline characteristics. After a median follow-up period of 6.6 years, 8704 events of new-onset dementia occurred. Among all AF patients developing dementia, 73% were classified as having Alzheimer's disease, 16% as having vascular dementia, and 11% as having other/mixed dementia. The cumulative incidence of dementia in AF patients was higher than those without AF (log-rank test: P < 0.001 for both before and after IPTW). In patients with AF undergoing catheter ablation, the total dementia risk decreased significantly [P = 0.015, hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.58-0.94] after multivariable adjustment, but not for the subtype of vascular dementia (P = 0.59, HR: 0.86, 95% CI: 0.49-1.50). CONCLUSION Patients with AF have a higher incidence of all types of dementia, including Alzheimer's disease, vascular dementia, and a mixed type of dementia. Alzheimer's disease is less likely to occur in patients with AF undergoing catheter ablation.
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Affiliation(s)
- Guan-Yi Li
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Yun-Yu Chen
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yenn-Jiang Lin
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fa-Po Chung
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Li-Wei Lo
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Shih-Lin Chang
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Tze-Fan Chao
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Yu-Feng Hu
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Chin-Yu Lin
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
| | - Shih-Ann Chen
- Cardiovascular Center, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Fak AS. Atrial fibrillation burden and cognitive function; a new horizon in the digital health era? Int J Cardiol 2023; 378:40-41. [PMID: 36841292 DOI: 10.1016/j.ijcard.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Ali Serdar Fak
- Marmara University, Hypertension and Atherosclerosis Research Center, Istanbul, Turkey.
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Bodagh N, Kotadia I, Gharaviri A, Zelaya F, Birns J, Bhalla A, Sommerville P, Niederer S, O’Neill M, Williams SE. The Impact of Atrial Fibrillation Treatment Strategies on Cognitive Function. J Clin Med 2023; 12:3050. [PMID: 37176490 PMCID: PMC10179566 DOI: 10.3390/jcm12093050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
There is increasing evidence to suggest that atrial fibrillation is associated with a heightened risk of dementia. The mechanism of interaction is unclear. Atrial fibrillation-induced cerebral infarcts, hypoperfusion, systemic inflammation, and anticoagulant therapy-induced cerebral microbleeds, have been proposed to explain the link between these conditions. An understanding of the pathogenesis of atrial fibrillation-associated cognitive decline may enable the development of treatment strategies targeted towards the prevention of dementia in atrial fibrillation patients. The aim of this review is to explore the impact that existing atrial fibrillation treatment strategies may have on cognition and the putative mechanisms linking the two conditions. This review examines how components of the 'Atrial Fibrillation Better Care pathway' (stroke risk reduction, rhythm control, rate control, and risk factor management) may influence the trajectory of atrial fibrillation-associated cognitive decline. The requirements for further prospective studies to understand the mechanistic link between atrial fibrillation and dementia and to develop treatment strategies targeted towards the prevention of atrial fibrillation-associated cognitive decline, are highlighted.
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Affiliation(s)
- Neil Bodagh
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Ali Gharaviri
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Fernando Zelaya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan Birns
- St Thomas’ Hospital, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Ajay Bhalla
- St Thomas’ Hospital, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Peter Sommerville
- St Thomas’ Hospital, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- St Thomas’ Hospital, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
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Al-Kaisey AM, Parameswaran R, Bryant C, Anderson RD, Hawson J, Chieng D, Voskoboinik A, Sugumar H, West D, Azzopardi S, Finch S, Wong G, Joseph SA, McLellan A, Ling LH, Sanders P, Lee G, Kistler PM, Kalman JM. Impact of Catheter Ablation on Cognitive Function in Atrial Fibrillation: A Randomized Control Trial. JACC Clin Electrophysiol 2023:S2405-500X(23)00157-3. [PMID: 37227345 DOI: 10.1016/j.jacep.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Early postoperative cognitive dysfunction (POCD) has been reported following atrial fibrillation (AF) ablation. However, whether POCD is persistent long-term is unknown. OBJECTIVES The purpose of this study was to determine if AF catheter ablation is associated with persistent cognitive dysfunction at 12-month follow-up. METHODS This is a prospective study of 100 patients with symptomatic AF who failed at least 1 antiarrhythmic drug randomized to either ongoing medical therapy or AF catheter ablation and followed up for 12 months. Changes in cognitive performance were assessed using 6 cognitive tests administered at baseline and during follow-up (3, 6, and 12 months). RESULTS A total of 96 participants completed the study protocol. Mean age was 59 ± 12 years (32% women, 46% with persistent AF). The prevalence of new cognitive dysfunction in the ablation arm compared with the medical arm was as follows: at 3 months: 14% vs 2%; P = 0.03; at 6 months: 4% vs 2%; P = NS; and at 12 months: 0% vs 2%; P = NS. Ablation time was an independent predictor of POCD (P = 0.03). A significant improvement in cognitive scores was seen in 14% of the ablation arm patients at 12 months compared with no patients in the medical arm (P = 0.007). CONCLUSIONS POCD was observed following AF ablation. However, this was transient with complete recovery at 12-month follow-up.
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Affiliation(s)
- Ahmed M Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Clinical Psychology, Royal Women's Hospital, Melbourne, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Chieng
- Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Hariharan Sugumar
- Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Danielle West
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Sonia Azzopardi
- Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Sue Finch
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | - Geoffrey Wong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stephen A Joseph
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Alex McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Liang-Han Ling
- Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Peter M Kistler
- Department of Medicine, University of Melbourne, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
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11
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Chen YY, Lin YJ, Hsieh YC, Chien KL, Lin CH, Chung FP, Chen SA. Atrial fibrillation as a contributor to the mortality in patients with dementia: A nationwide cohort study. Front Cardiovasc Med 2023; 10:1082795. [PMID: 37077740 PMCID: PMC10106772 DOI: 10.3389/fcvm.2023.1082795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundKnowledge of the risk of death in patients with dementia is essential for planning preventive strategies. This study aimed to evaluate the effect of atrial fibrillation (AF) on death risks and other factors associated with death in patients with dementia and AF.MethodsWe conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database. We identified subjects with dementia diagnosed for the first time and AF diagnosed concomitantly between 2013 and 2014. Subjects under the age of 18 years were excluded. Age, sex, and CHA2DS2-VASc scores were 1: 4 matched for AF patients (N = 1,679) and non-AF controls (N = 6,176) using the propensity score technique. The conditional Cox regression model and competing risk analysis were applied. The risk of mortality was tracked till 2019.ResultsAF history was associated with higher risks of all-cause death (hazard ratio [HR]: 1.208; 95% confidence interval [CI]: 1.142–1.277) and cardiovascular death (subdistribution HR: 1.210; 95% CI: 1.077–1.359) in dementia patients than patients without a diagnosis of AF. For patients with both dementia and AF, they had a higher risk of death due to higher age, diabetes mellitus, congestive heart failure, chronic kidney disease, and prior stroke. Anti-arrhythmic drugs and novel oral anticoagulants significantly reduced the risk of death in patients with AF and dementia.ConclusionThis study found that AF is a risk factor for mortality in patients with dementia and explored several risk factors for AF-related mortality. This study highlights the importance of controlling AF especially in patients with dementia.
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Affiliation(s)
- Yun-Yu Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Correspondence: Yenn-Jiang Lin
| | - Yu-Cheng Hsieh
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fa-Po Chung
- Cardiovascular Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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Zeitler EP, Bunch TJ, Khanna R, Fan X, Iglesias M, Russo AM. Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs. Am Heart J 2022; 254:194-202. [PMID: 36245141 DOI: 10.1016/j.ahj.2022.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of dementia. Emerging evidence suggests AF suppression is associated with reduced risk of dementia, but the optimal strategy to achieve this is unknown. We sought to compare the risk of dementia in patients with AF who underwent catheter ablation (CA) versus anti-arrhythmic drug (AAD) treatment. METHODS AND RESULTS: Using the 2000 to 2021 Optum Clinformatics database, patients with AF who underwent CA versus AAD treatment (≥1 prescription fill for ≥2 different AADs) were identified and propensity score matched overall and within sex subgroups. A cause-specific hazard model was performed to assess dementia overall and in sex-specific subgroups. After matching, there were 19,088 patients per group. CA was associated with a 41% lower risk of dementia compared with AAD alone (1.9% vs 3.3%; hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.52-0.67, log-rank P < .0001). When examined by sex, dementia risk reduction associated with CA versus AAD use alone was observed among both males (HR 0.55, 95% CI 0.46-0.66) and females (HR 0.60, 95% CI 0.50-0.72). Though not studied as a primary outcome, patients treated with CA were also observed to have 49% lower associated risk of mortality compared with AAD only (HR 0.51 95% CI 0.46-0.55, P < .0001). CONCLUSIONS: Among patients treated for AF, CA was associated with significantly lower risk of dementia and death compared with AADs only. These reductions in risk associated with CA versus AAD were seen in both males and females.
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Affiliation(s)
| | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, UT
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ
| | - Xiaozhou Fan
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ
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13
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Terrosu P. Association between heart and dementia… keep an eye on the left atrium. Eur Heart J Suppl 2022; 24:I186-I189. [PMID: 36380789 PMCID: PMC9653143 DOI: 10.1093/eurheartjsupp/suac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Atrial fibrillation is associated with an increased risk of cognitive impairment and dementia. The mechanisms are not well known, but they are probably multifactorial and involve atrial myopathy, cardio-embolism, cerebral hypoperfusion, and comorbidities (systemic vascular sclerosis, disease of the small cerebral vessels, inflammation, etc.). Atrial fibrillation therapy could have a protective effect on dementia through diversified actions: (i) prevention of left atrial remodelling; (ii) prevention of cardio-embolism and silent (and not) cerebral infarcts; (iii) improvement of cardiac output and cerebral perfusion. Randomized trials will be needed to clarify the links between left atrium and dementia and to identify the most appropriate therapeutic strategies.
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14
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Bodagh N, Yap R, Kotadia I, Sim I, Bhalla A, Somerville P, O'Neill M, Williams SE. Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review. J Interv Card Electrophysiol 2022; 65:271-286. [PMID: 35380337 PMCID: PMC9550702 DOI: 10.1007/s10840-022-01196-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether the restoration of sinus rhythm with catheter ablation may modify this risk. We conducted a systematic review of studies comparing cognitive outcomes following catheter ablation with medical therapy (rate and/or rhythm control) in atrial fibrillation. METHODS Searches were performed on the following databases from their inception to 17 October 2021: PubMed, OVID Medline, Embase and Cochrane Library. The inclusion criteria comprised studies comparing catheter ablation against medical therapy (rate and/or rhythm control in conjunction with anticoagulation where appropriate) which included cognitive assessment and/or a diagnosis of dementia as an outcome. RESULTS A total of 599 records were screened. Ten studies including 15,886 patients treated with catheter ablation and 42,684 patients treated with medical therapy were included. Studies which compared the impact of catheter ablation versus medical therapy on quantitative assessments of cognitive function yielded conflicting results. In studies, examining new onset dementia during follow-up, catheter ablation was associated with a lower risk of subsequent dementia diagnosis compared to medical therapy (hazard ratio: 0.60 (95% confidence interval 0.42-0.88, p < 0.05)). CONCLUSION The accumulating evidence linking atrial fibrillation with cognitive impairment warrants the design of atrial fibrillation treatment strategies aimed at minimising cognitive decline. However, the impact of catheter ablation and atrial fibrillation medical therapy on cognitive decline is currently uncertain. Future studies investigating atrial fibrillation treatment strategies should include cognitive outcomes as important clinical endpoints.
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Affiliation(s)
- Neil Bodagh
- King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Reuben Yap
- Princess Royal University Hospital, Orpington, UK
| | - Irum Kotadia
- King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Iain Sim
- King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ajay Bhalla
- Guys and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Mark O'Neill
- King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Steven E Williams
- King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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15
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Chen P, Chen Z, Pan D, Miao L, Shi Y, Guo M, Du J. Catheter ablation and cognitive function in atrial fibrillation: A systematic review and meta-analysis. Front Neurol 2022; 13:934512. [PMID: 36158973 PMCID: PMC9492882 DOI: 10.3389/fneur.2022.934512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Atrial fibrillation (AF) is a risk factor for cognitive dysfunction. Although catheter ablation (CA) is one of the main treatments for AF, whether it can improve cognitive function in patients with AF remains unclear. We conducted a systematic review and meta-analysis to evaluate the cognitive outcome post-CA procedure. Methods Two investigators independently searched the PubMed, EMBASE, Web of Science, CNKI, WanFang, and VIP databases from inception to September 2021 for all the potentially eligible studies. The outcomes of interest included dementia or cognitive disorder through scoring or recognized classification criteria. Heterogeneity was determined by using Cochrane's Q test and calculating the I2. A random-effects model was used to incorporate the potential effects of heterogeneity. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence. Result Thirteen studies including 40,868 patients were included, among which 12,086 patients received AF ablation. Meta-analysis indicated that patients with AF ablation had a lower risk of dementia incidence in comparison to patients with AF without ablation [hazard ratio (HR): 0.60, 95% CI: 0.43 to 0.84, p = 0.003 I2 = 40%]. Significant differences were observed in the incidence of new-onset dementia [risk ratio (RR): 0.43, 95% CI: 0.28 to 0.65, p < 0.0001 I2 = 84%]; the changes in the Montreal Cognitive Assessment (MoCA) score [weighted mean difference (WMD): 1.00, 95% CI: 0.36 to 1.64, p < 0.005 I2 = 0%] and Mini-Mental State Examination (MMSE) score (WMD: 0.98, 95% CI: 0.69 to 1.26, p < 0.00001 I2 = 0%]. However, in subgroup analysis, we did not observe significant changes in MoCA score at < 3 months (WMD: 1.20, 95% CI: −0.19 to 2.58, p = 0.09 I2 = 50%) and changes in cognitive function scores between the radiofrequency group and cryoballoon group [standard mean difference (SMD): 0.39, 95% CI: −0.47 to 1.24, p = 0.38 I2 = 87%]. The NOS indicated that included studies were moderate to high quality, while the quality of evidence assessed by GRADE was low in 2 and very low in 2. Conclusion We analyzed the related cognitive outcomes after AF ablation. In the overall population, AF ablation had a positive trend for improving cognitive function at >3 months post-procedure. However, AF ablation might not be related to the improvement of cognitive function at < 3 months. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285198.
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Affiliation(s)
- Pengfei Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuhong Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Deng Pan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Lina Miao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yujiao Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ming Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Ming Guo
| | - Jianpeng Du
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Jianpeng Du
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16
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Giannone ME, Filippini T, Whelton PK, Chiari A, Vitolo M, Boriani G, Vinceti M. Atrial Fibrillation and the Risk of Early‐Onset Dementia: A Systematic Review and Meta‐Analysis. J Am Heart Assoc 2022; 11:e025653. [PMID: 35861843 PMCID: PMC9707836 DOI: 10.1161/jaha.122.025653] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Recent studies have identified an increased risk of dementia in patients with atrial fibrillation (AF). However, both AF and dementia usually manifest late in life. Few studies have investigated this association in adults with early‐onset dementia. The aim of this study was to investigate the relationship between AF and early‐onset dementia.
Methods and Results
We searched the PubMed/MEDLINE, Embase, and Scopus databases through April 15, 2022, for studies reporting on the association between AF and dementia in adults aged <70 years, without language restrictions. Two reviewers independently performed the study selection, assessed the risk of bias, and extracted the study data. We performed a meta‐analysis of early‐onset dementia risk according to occurrence of AF using a random‐effects model. We retrieved and screened 1006 potentially eligible studies. We examined the full text of 33 studies and selected the 6 studies that met our inclusion criteria. The pooled analysis of their results showed an increased risk of developing dementia in individuals with AF, with a summary relative risk of 1.50 (95% CI, 1.00–2.26) in patients aged <70 years, and 1.06 (95% CI, 0.55–2.06) in those aged <65 years.
Conclusions
In this systematic review and meta‐analysis, AF was a risk factor for dementia in adults aged <70 years, with an indication of a slight and statistically imprecise excess risk already at ages <65 years. Further research is needed to assess which characteristics of the arrhythmia and which mechanisms play a role in this relationship.
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Affiliation(s)
- Maria Edvige Giannone
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
- School of Public Health University of California Berkeley Berkeley CA
| | - Paul K. Whelton
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Annalisa Chiari
- Neurology Unit, Department of Neurosciences Azienda Ospedaliero Universitaria di Modena Modena Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center University of Modena and Reggio Emilia Modena Italy
- Department of Epidemiology Boston University School of Public Health Boston MA
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17
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Saglietto A, Ballatore A, Xhakupi H, De Ferrari GM, Anselmino M. Association of Catheter Ablation and Reduced Incidence of Dementia among Patients with Atrial Fibrillation during Long-Term Follow-Up: A Systematic Review and Meta-Analysis of Observational Studies. J Cardiovasc Dev Dis 2022; 9:jcdd9050140. [PMID: 35621851 PMCID: PMC9143892 DOI: 10.3390/jcdd9050140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Atrial fibrillation (AF) is independently associated with the onset of cognitive decline/dementia. AF catheter ablation (AFCA) is the most effective treatment strategy in terms of sinus rhythm maintenance, but its effects on dementia prevention remain under investigation. The aim of the present study was to perform a systematic review and meta-analysis of the presently available studies exploring the effect of AFCA on dementia occurrence. Methods: PubMed/MEDLINE databases were screened for articles through 14 March 2022 reporting adjusted time-to-event outcome data comparing AFCA and non-AFCA cohorts in terms of de novo dementia occurrence. A random effect meta-analysis was performed to estimate the meta-analytic hazard ratio (HR) of dementia occurrence in AFCA vs. non-AFCA cohorts, as well as the meta-analytic incidence rate of dementia in the non-AFCA cohort. Based on the aforementioned estimates, the number needed to treat (NNT), projected at median follow-up, was derived. Results: Four observational studies were included in the analysis, encompassing 40,146 patients (11,312 in the AFCA cohort; 28,834 in the non-AFCA cohort). AFCA conferred a significant protection to the development of dementia with an overall HR of 0.52 (95% CI 0.35–0.76). The incidence rate of dementia in the non-AFCA group was 1.12 events per 100 person-year (95% CI 0.47–2.67). The derived NNT projected to the median follow-up (4.5 years) was 41. Conclusion: AFCA is associated with a nearly 50% reduction in dementia occurrence during a median 4.5-year follow-up. Future randomized clinical trials are needed to reinforce these findings.
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18
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Lin JC, Li CH, Chen YY, Weng CJ, Chien YS, Wu SJ, Lo CP, Tien HC, Lin CH, Huang JL, Lin YJ, Hsieh YC, Chen SA. Rhythm Control Better Prevents Dementia than Rate Control Strategies in Patients with Atrial Fibrillation-A Nationwide Cohort Study. J Pers Med 2022; 12:jpm12040572. [PMID: 35455688 PMCID: PMC9025212 DOI: 10.3390/jpm12040572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Atrial fibrillation (AF) increases the risk of dementia. Whether the pharmacological rhythm control of AF can reduce the risk of dementia compared to the rate control strategy remains unclear. We hypothesize that the rhythm control strategy is better than the rate control strategy in preventing dementia. Methods: AF patients aged ≥65 years were identified from the Taiwan National Health Insurance Database. Patients receiving anti-arrhythmic drugs at a cumulative defined daily dose (cDDD) of >30 within the first year of enrollment constituted the rhythm control group. Patients who used rate control medications for a cDDD of >30 constituted the rate control group. A multivariate Cox hazards regression model was used to determine the hazard ratio (HR) for dementia. Results: A total of 3382 AF patients (698 in the rhythm control group; 2684 in the rate control group) were analyzed. During a 4.86 ± 3.38 year follow-up period, 414 dementia events occurred. The rhythm control group had a lower rate of dementia than the rate control group (adjust HR: 0.75, p = 0.031). The rhythm control strategy reduced the risk of dementia particularly in those receiving aspirin (p = 0.03). Conclusions: In patients with AF, pharmacological rhythm control was associated with a lower risk of dementia than rate control over a long-term follow-up period, particularly in patients receiving aspirin treatment.
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Affiliation(s)
- Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Yun-Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10617, Taiwan
| | - Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Yu-Shan Chien
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Shang-Ju Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
| | - Hui-Chun Tien
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40704, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- School of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yenn-Jiang Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
- School of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence: ; Tel.: +886-4-2251-6648; Fax: +886-4-2359-9257
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
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19
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Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association. Medicina (B Aires) 2022; 58:medicina58030361. [PMID: 35334537 PMCID: PMC8955523 DOI: 10.3390/medicina58030361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022] Open
Abstract
Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed.
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20
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Burnham TS, Scott ML, Steinberg BA, Varela DL, Zenger B, Bunch TJ. Impact of Catheter Ablation on Stroke, Cognitive Decline and Dementia. Arrhythm Electrophysiol Rev 2021; 10:205-210. [PMID: 34777826 PMCID: PMC8576494 DOI: 10.15420/aer.2021.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
AF has been consistently associated with multiple forms of dementia, including idiopathic dementia. Outcomes after catheter ablation for AF are favourable and patients experience a better quality of life, arrhythmia-free survival, and lower rates of hospitalisation compared to patients treated with antiarrhythmic drugs. Catheter ablation is consistently associated with lower rates of stroke compared to AF management without ablation in large national and healthcare system databases. Multiple observational trials have shown that catheter ablation is also associated with a lower risk of cognitive decline, dementia and improved cognitive testing that can be explained through a variety of pathways. Long-term, adequately powered, randomised trials are required to define the role of catheter ablation in the management of AF as a means to lower the risk of cognitive decline, stroke and dementia.
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Affiliation(s)
- Tyson S Burnham
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
| | - Monte L Scott
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
| | - Benjamin A Steinberg
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
| | - Daniel L Varela
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
| | - Brian Zenger
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
| | - T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, US
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21
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Wang X, Wang Z, Yan X, Huang M, Wu Y. Radiofrequency and cryoballoon ablation improve cognitive function in patients with atrial fibrillation. Medicine (Baltimore) 2021; 100:e26914. [PMID: 34397930 PMCID: PMC8360464 DOI: 10.1097/md.0000000000026914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/23/2021] [Indexed: 01/04/2023] Open
Abstract
Atrial fibrillation is considered to be the most common arrhythmia in the clinic, and it gradually increases with age. In recent years, there has been increasing evidence that atrial fibrillation may exacerbate the progression of cognitive dysfunction. The current guidelines recommend ablation for drug-refractory atrial fibrillation.We aimed to prospectively analyze changes in cognitive function in patients with atrial fibrillation following treatment using different ablation methods.A total of 139 patients, with non-valvular atrial fibrillation, were included in the study. The patients were divided into the drug therapy (n = 41) and catheter ablation (n = 98) groups, with the catheter ablation group further subdivided into radiofrequency ablation (n = 68) and cryoballoon (CY) ablation (n = 30). We evaluated cognitive function at baseline, 3- and 12-months follow-up using the Telephone Interview for Cognitive Status-modified (TICS-m) test, then analyzed differences in cognitive function between the drug therapy and catheter ablation groups, to reveal the effect of the different ablation methods.We observed a significantly higher TICS-m score (39.56 ± 3.198) in the catheter ablation group at 12-month follow-up (P < .001), than the drug treatment group was. Additionally, we found no statistically significant differences in TICS-m scores between the radiofrequency ablation and CY groups at 3- and 12-month postoperatively (P > .05), although the two subgroups showed statistically significant cognitive function (P < .001).Overall, these findings indicated that radiofrequency and CY ablation improve cognitive function in patients with atrial fibrillation.
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22
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Benenati S, Canale C, De Marzo V, Della Bona R, Rosa GM, Porto I. Atrial fibrillation and Alzheimer's disease: A conundrum. Eur J Clin Invest 2021; 51:e13451. [PMID: 33219514 DOI: 10.1111/eci.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/01/2022]
Abstract
During ageing, the prevalence of Alzheimer's disease (AD) and of cardiovascular disease CVD) increases. Our aim is to investigate the relationship between AD and CVD and its risk factors, with a view to explaining the underlying mechanisms of this association. This review is based on the material obtained via MEDLINE (PubMed), Embase and Clinical Trials databases, from January 1980 until May 2019. The search term used was "Alzheimer's disease", combined with "cardiovascular disease", "hypertension", "dyslipidaemia", "diabetes mellitus", "atrial fibrillation", "coronary artery disease", "heart valve disease", "heart failure". Out of the 1328 papers initially retrieved, 431 duplicates and 216 records in languages other than English were removed; thus, only 98 papers were included in our research material. We have found that AD and CVD are frequently associated, while both of them, alone may be considered deleterious to health, the study of their combination constitutes a clinical challenge. Further research will help to clarify the real impact of CVD and its risk factors on AD, in order to better comprehend the effects of subclinical and clinical cardiovascular diseases on the brain. It may be hypothesized that there are various mechanisms underlying the association between AD and CVD, the main ones being: hypoperfusion and emboli, atherosclerosis, furthermore in both the heart and brain of AD patients, amyloid deposits may be present, thus causing damage to these organs. We need to clarify the real impact of these underlying hypothesized mechanisms and to investigate gender issues.
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Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Claudia Canale
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Vincenzo De Marzo
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Roberta Della Bona
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Gian Marco Rosa
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
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23
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De Marchis GM, Sposato LA, Kühne M, Dittrich TD, Bonati LH, Fischer U, Chaturvedi S. New Avenues for Optimal Treatment of Atrial Fibrillation and Stroke Prevention. Stroke 2021; 52:1490-1499. [PMID: 33626906 DOI: 10.1161/strokeaha.120.032060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
One in 3 individuals free of atrial fibrillation (AF) at index age 55 years is estimated to develop AF later in life. AF increases not only the risk of ischemic stroke but also of dementia, even in stroke-free patients. In this review, we address recent advances in the heart-brain interaction with focus on AF. Issues discussed are (1) the timing of direct oral anticoagulants start following an ischemic stroke; (2) the comparison of direct oral anticoagulants versus vitamin K antagonists in early secondary stroke prevention; (3) harms of bridging with heparin before direct oral anticoagulants; (4) importance of appropriate direct oral anticoagulants dosing; (5) screening for AF in high-risk populations, including the role of wearables; (6) left atrial appendage occlusion as an alternative to oral anticoagulation; (7) the role of early rhythm-control therapy; (8) effect of lifestyle interventions on AF; (9) AF as a risk factor for dementia. An interdisciplinary approach seems appropriate to address the complex challenges posed by AF.
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Affiliation(s)
- Gian Marco De Marchis
- Department of Neurology (G.M.D.M., T.D.D., L.H.B.), University Hospital Basel, Switzerland
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Center (L.A.S.), Western University, London, Ontario, Canada.,Heart & Brain Lab (L.A.S.), Western University, London, Ontario, Canada
| | - Michael Kühne
- Department of Cardiology (M.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (M.K.), University Hospital Basel, Switzerland
| | - Tolga D Dittrich
- Department of Neurology (G.M.D.M., T.D.D., L.H.B.), University Hospital Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology (G.M.D.M., T.D.D., L.H.B.), University Hospital Basel, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, University of Bern, Switzerland (U.F.)
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore (S.C.)
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24
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association? Angiology 2020; 71:498-519. [DOI: 10.1177/0003319720910669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Growing evidence suggests that atrial fibrillation (AF), in addition to its thromboembolic risk, is a risk factor for cognitive impairment (CI) via several pathways and mechanisms, further contributing to morbidity/mortality. Prior stroke is a contributor to CI, but AF is also associated with CI independently from prior stroke. Silent brain infarctions, microemboli and microbleeds, brain atrophy, cerebral hypoperfusion from widely fluctuating ventricular rates, altered hemostatic function, vascular oxidative stress, and inflammation may all exacerbate CI, particularly in patients with persistent/permanent rather than paroxysmal AF and with increased duration/burden of the arrhythmia. Brain magnetic resonance imaging is an important screening tool in eliciting and monitoring vascular and nonvascular lesions contributing to CI. Evidence is also emerging about the role of genetics in CI development. Anticoagulation and rhythm/rate control strategies may protect against CI preventing or slowing its progression or conversion to dementia, particularly at the early stages when CI may still be a treatable condition. Importantly, AF and CI share many common risk factors. Thus, screening for these 2 conditions and searching for and managing modifiable risk factors and potentially reversible causes for both AF and CI remains an important step toward prevention or amelioration of the impact incurred by these 2 conditions.
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Affiliation(s)
| | | | | | | | - Antonis S. Manolis
- First and Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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