Atrial fibrillation (AF) is currently the most common sustained cardiac arrhythmia worldwide with an overall prevalence of up to 5.5%, which increases with increasing age. It is associated with significant morbidity and mortality. AF is one of the leading causes of congestive heart failure and thromboembolism, including ischemic stroke. Several prospective, multicenter clinical trials have been conducted in recent years to assess the impact of AF on cognitive function. These have identified AF as an independent predictor of cognitive impairment in patients without overt stroke to various degrees. Controversial issues of rate or rhythm control and anticoagulation have been at the forefront of research, with conflicting results in a growing body of literature leading to rapidly changing published guidelines and position papers for the management of AF. With the development of ablation for the treatment of AF, particularly with various new energy sources and catheters, an additional source of thromboembolism is introduced and methods to reduce this risk need to be considered. The importance lies in the fact that cognitive impairment leads to decreased ability to self-care, to manage a complex disease, and subsequently to decreased quality-of-life and increased hospitalizations.
Here we review the evidence behind the association of AF with cognitive dysfunction, and discuss the current medical and procedural treatment strategies available for preserving cognitive function in patients with AF.
Credits: Tina Lin MD; Erik Wissner MD; Roland Tilz MD; Andreas Rillig MD; Shibu Mathew MD; Peter Rausch MD; Christine Lemes MD; Sebastian Deiss MD; Masashi Kamioka MD; Tudor Bucur MD; Feifan Ouyang MD; Karl-Heinz Kuck MD; Andreas Metzner MD