Prevalence of Silent Cerebral Ischemia in Paroxysmal and Persistent Atrial Fibrillation and Correlation With Cognitive Function

Study Questions:

What is the prevalence of silent cerebral ischemia (SCI) and cognitive performance in paroxysmal and persistent atrial fibrillation (AF) patients and controls in sinus rhythm (SR)?

Methods:

Two hundred-seventy subjects were enrolled: 180 patients with AF (50% paroxysmal and 50% persistent) and 90 controls. All subjects received clinical assessment, neurological examination, cerebral magnetic resonance (MR), and underwent the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). A logistic regression model was performed to determine the correlation between SCI and potential confounders selected at univariate analysis (p < 0.5).

Results:

At least one SCI was present in 80 (89%) patients with paroxysmal AF, 83 (92%) with persistent AF (paroxysmal vs. persistent; p = 0.59), and in 41 (46%) controls (paroxysmal vs. controls and persistent vs. controls; p < 0.01). Number of SCI per person was higher in persistent than in paroxysmal AF patients (41.1 ± 28.0 vs. 33.2 ± 22.8; p = 0.04), with controls reporting lower figures (12.0 ± 26.7; both p < 0.01). Cognitive performance was significantly worse in persistent and paroxysmal AF patients than in controls (RBANS 82.9 ± 11.5, 86.2 ± 13.8, and 92.4 ± 15.4 points respectively; p < 0.01).

Conclusions:

The authors concluded that paroxysmal and persistent AF patients presented a higher prevalence and number of SCI per patient than controls, and confirmed a worse cognitive performance than subjects in SR.

Perspective:

This study reported that AF patients (both paroxysmal and persistent) presented higher prevalence of SCI and worse cognitive performance compared to controls, and despite similar cognitive function by RBANS between paroxysmal and persistent AF patients, visual-spatial abilities were worse in persistent AF. The present data would appear to suggest that an initially limited cerebral damage may become overt as the number of cerebral lesions increases due to persistence of the arrhythmia. The most important clinically relevant question is whether prophylactic antithrombotic treatment may be able to reduce the incidence of silent brain lesions as it has been proven to do for clinical strokes, and will require appropriately designed and powered prospective studies to answer this question.

Clinical Topics: Vascular Medicine

Keywords: Stroke, Heart Atria, Cognition Disorders, Brain Ischemia, Neurologic Examination, Incidence, Prevalence, Cerebral Infarction, Neuropsychological Tests, Brain Injuries, Magnetic Resonance Spectroscopy, Logistic Models


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