Atrial Fibrillation is Associated with Decreased Total Cerebral Blood Flow and Brain Perfusion

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2017 Oct 11

PMID 29016776

Citations 61

Authors

Marianna Gardarsdottir

Sigurdur Sigurdsson

Thor Aspelund

Hrafnhildur Rokita

Lenore J Launer

Vilmundur Gudnason

David O Arnar

Affiliations

Soon will be listed here.

Abstract

Aims: Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF.

Methods And Results: Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study. Individuals were divided into three groups at the time of the MRI: persistent AF, paroxysmal AF, and no history of AF. Of 2291 participants (mean age 79.5 years), 117 had persistent AF and 78 had paroxysmal AF but were in sinus rhythm at the time of imaging AF. Those with persistent AF had lower cholesterol and used more anti-hypertensive medication and warfarin. The three groups were similar with regard to other cardiovascular risk factors. Those in the persistent AF group had significantly lower total cerebral blood flow on average, 472.1 mL/min, both when compared with the paroxysmal AF group, 512.3 mL/min (P < 0.05) and the no AF group, 541.0 mL/min (P < 0.001). Brain perfusion was lowest in the persistent AF group, 46.4 mL/100 g/min compared with the paroxysmal AF group, 50.9 mL/100 g/min in (P < 0.05) and those with no AF, 52.8 mL/100 g/min (P < 0.001).

Conclusion: Persistent AF decreases blood flow to the brain as well as perfusion of brain tissue compared with sinus rhythm.

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References

Harris T, Launer L, Eiriksdottir G, Kjartansson O, Jonsson P, Sigurdsson G . Age, Gene/Environment Susceptibility-Reykjavik Study: multidisciplinary applied phenomics. Am J Epidemiol. 2007; 165(9):1076-87. PMC: 2723948. DOI: 10.1093/aje/kwk115. View

Ott A, Breteler M, de Bruyne M, Van Harskamp F, Grobbee D, Hofman A . Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997; 28(2):316-21. DOI: 10.1161/01.str.28.2.316. View

Barkhof F, Tas M, Frequin S, Scheltens P, Hommes O, Nauta J . Limited duration of the effect of methylprednisolone on changes on MRI in multiple sclerosis. Neuroradiology. 1994; 36(5):382-7. DOI: 10.1007/BF00612124. View

Petersen P, Kastrup J, Videbaek R, Boysen G . Cerebral blood flow before and after cardioversion of atrial fibrillation. J Cereb Blood Flow Metab. 1989; 9(3):422-5. DOI: 10.1038/jcbfm.1989.62. View

Kalantarian S, Stern T, Mansour M, Ruskin J . Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med. 2013; 158(5 Pt 1):338-46. PMC: 4465526. DOI: 10.7326/0003-4819-158-5-201303050-00007. View

Knecht S, Oelschlager C, Duning T, Lohmann H, Albers J, Stehling C . Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J. 2008; 29(17):2125-32. DOI: 10.1093/eurheartj/ehn341. View

LAVY S, Stern S, Melamed E, Cooper G, Keren A, Levy P . Effect of chronic atrial fibrillation on regional cerebral blood flow. Stroke. 1980; 11(1):35-8. DOI: 10.1161/01.str.11.1.35. View

Dietzel J, Haeusler K, Endres M . Does atrial fibrillation cause cognitive decline and dementia?. Europace. 2017; 20(3):408-419. DOI: 10.1093/europace/eux031. View

Porebska A, Nowacki P, Safranow K, Drechsler H . Nonembolic, hemodynamic blood flow disturbances in the middle cerebral arteries in patients with paroxysmal atrial fibrillation without significant carotid stenosis. Clin Neurol Neurosurg. 2007; 109(9):753-7. DOI: 10.1016/j.clineuro.2007.06.001. View

10.

Stefansdottir H, Arnar D, Aspelund T, Sigurdsson S, Jonsdottir M, Hjaltason H . Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke. 2013; 44(4):1020-5. PMC: 3632359. DOI: 10.1161/STROKEAHA.12.679381. View

11.

Totaro R, Corridoni C, Marini C, Marsili R, Prencipe M . Transcranial Doppler evaluation of cerebral blood flow in patients with paroxysmal atrial fibrillation. Ital J Neurol Sci. 1993; 14(6):451-4. DOI: 10.1007/BF02339175. View

12.

Ikram M, Vrooman H, Vernooij M, den Heijer T, Hofman A, Niessen W . Brain tissue volumes in relation to cognitive function and risk of dementia. Neurobiol Aging. 2008; 31(3):378-86. DOI: 10.1016/j.neurobiolaging.2008.04.008. View

13.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016; 18(11):1609-1678. DOI: 10.1093/europace/euw295. View

14.

Marcoux F, Morawetz R, CROWELL R, DeGirolami U, Halsey Jr J . Differential regional vulnerability in transient focal cerebral ischemia. Stroke. 1982; 13(3):339-46. DOI: 10.1161/01.str.13.3.339. View

15.

Sigurdsson S, Forsberg L, Aspelund T, van der Geest R, van Buchem M, Launer L . Feasibility of Using Pseudo-Continuous Arterial Spin Labeling Perfusion in a Geriatric Population at 1.5 Tesla. PLoS One. 2015; 10(12):e0144743. PMC: 4687637. DOI: 10.1371/journal.pone.0144743. View

16.

Efimova I, Efimova N, Chernov V, Popov S, Lishmanov Y . Ablation and pacing: improving brain perfusion and cognitive function in patients with atrial fibrillation and uncontrolled ventricular rates. Pacing Clin Electrophysiol. 2011; 35(3):320-6. DOI: 10.1111/j.1540-8159.2011.03277.x. View

17.

Bonekamp D, Degaonkar M, Barker P . Quantitative cerebral blood flow in dynamic susceptibility contrast MRI using total cerebral flow from phase contrast magnetic resonance angiography. Magn Reson Med. 2011; 66(1):57-66. PMC: 3140063. DOI: 10.1002/mrm.22776. View

18.

Wutzler A, Nee J, Boldt L, Kuhnle Y, Graser S, Schroder T . Improvement of cerebral oxygen saturation after successful electrical cardioversion of atrial fibrillation. Europace. 2013; 16(2):189-94. DOI: 10.1093/europace/eut246. View

19.

Elbers P, Prins W, Plokker H, van Dongen E, van Iterson M, Ince C . Electrical cardioversion for atrial fibrillation improves microvascular flow independent of blood pressure changes. J Cardiothorac Vasc Anesth. 2012; 26(5):799-803. DOI: 10.1053/j.jvca.2012.04.016. View

20.

Hui D, Morley J, Mikolajczak P, Lee R . Atrial fibrillation: A major risk factor for cognitive decline. Am Heart J. 2015; 169(4):448-56. DOI: 10.1016/j.ahj.2014.12.015. View