Increased beat-to-beat variability of cerebral microcirculatory perfusion during atrial fibrillation: a near-infrared spectroscopy study

Saglietto, Andrea; Scarsoglio, Stefania; Canova, Daniela; Roatta, Silvestro; Gianotto, Nefer; Piccotti, Alessandro; Franzin, Simone Medianeira; Gaïta, Fiorenzo; Ferrari, Gaetano Maria De; Ridolfi, Luca; Anselmino, Matteo

doi:10.1093/europace/euab070

Cited by 24 publications

(41 citation statements)

References 17 publications

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“…A computational model of cerebral circulation during AF also demonstrated that the irregularity in cardiac cycles led to transient episodes of hypoperfusion and hypertension in the deep cerebral circle [ 5 , 6 ]. This finding was recently confirmed in vivo by spatially resolved cerebral near-infrared spectroscopy (SRS-NIRS): interestingly, restoration of sinus rhythm by cardioversion related to a reduction in the abnormal cerebral hemodynamic events and normalization of brain tissue perfusion [ 26 ]. In this respect, the Acute Cognitive Changes During Atrial Fibrillation Episodes (AFCOG) study will evaluate the acute effect of an AF episode on cognitive function (NCT04033510) in patients managed by rhythm control strategy [ 27 ].…”

Section: Discussionmentioning

confidence: 87%

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

Saglietto

Ballatore

Xhakupi

et al. 2022

JCDD

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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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Section: Discussionmentioning

confidence: 87%

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

Saglietto

Ballatore

Xhakupi

et al. 2022

JCDD

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“…-Extreme hemodynamic events: AF-related beat-to-beat variability, assessed by spatially resolved near-infrared spectroscopy, alters cerebral microvascular perfusion by inducing transient and repetitive hypoperfusions or hypertensive events in the deep cerebral circle. Interestingly, while these events disappear after sinus rhythm restoration by electrical cardioversion, the same does not occur in a comparable subgroup of AFL patients, supporting the hypothesis that a more regular ventricular response results less impacting on the deep cerebral circle ( 8 ).…”

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confidence: 71%

Commentary: Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

Saglietto

Ferrari

Anselmino

2022

Front. Cardiovasc. Med.

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Atrial fibrillation and atrial flutter: cousin arrhythmias, but non that close. The recent article by Wang et al. (1) provides unprecedented insights on an issue that the scientific community overly takes for granted. Since decades, atrial fibrillation (AF) and atrial flutter (AFL) have been considered as different manifestation of the same disease, and practical guidelines recommend a similar management, in terms of oral anticoagulation prescription, for both AF and AFL (2). However, the pathophysiological background and the clinical presentation of the two conditions are different, particularly related to the ventricular response, completely irregular ("irregularly irregular") during AF, while generally regular (or, at least, a "regular/modular irregularity") during AFL. Based on this profound hemodynamic difference, there is a strong scientific rationale that the two "cousin" arrhythmias might present relevant distinctions. Indeed, it was recently suggested that a differential risk in hard clinical endpoints truly exists, with AF presenting a 63, 70, and 8% increased risk of ischemic stroke, heart failure hospitalization and mortality, respectively, if compared to patients with AFL only (3). In his recent article (1), Wang extends the spectrum of clinical differences between AF and AFL. On two propensity-matched cohorts from Taiwan's National Health Insurance Research Database and another dataset (study period 2001-2013), AF relates to an increased risk of dementia compared to AFL, independently from oral anticoagulation (hazard ratio, HR 1.14, 95% CI 1.04-1.25 in patients without oral anticoagulation, and 1.57, 95% CI 1.00-2.45 in patients on warfarin therapy). If on one hand this increased risk of dementia can be partly explained by an increased propension of AF patients to suffer an ischemic stroke, both in non-anticoagulated (HR 1.76,) and anticoagulated subjects (HR 2.54, 95% CI 1.56-4.12), other mechanisms might certainly be involved.AF patients are known to be more susceptible to subclinical cardiogenic microembolic phenomena leading to silent cerebral ischemias (4), likely not completely preventable by oral anticoagulation therapy. In addition, a critical role might be played by the rhythm itself, considering the irregularly irregularity of AF, compared to the more regular ventricular response in AFL. In fact, recent evidences point toward a critical role of AF rhythm per se on cerebral hemodynamics:-Reduced mean cerebral blood flow: Gardsdottir et al. ( 5) demonstrated, at phase contrast MRI, that cerebral blood flow in patients with persistent AF is reduced by about 10%, compared to both paroxysmal AF patients (in sinus rhythm at the time of the test) and controls. In a subsequent analysis, persistent AF patients undergoing elective electrical cardioversion, showed,

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“…The latter hypothesis was also recently validated in vivo using spatially resolved cerebral near infrared spectroscopy (SRS-NIRS). Elective electrical cardioversion restoration sinus rhythm in persistent AF patients, significantly reduced beat-to-beat hypoperfusion and hypertensive events in the cerebral microcirculation, assessed by inter-beat differences of tissue hemoglobin index, an indirect index of tissue perfusion [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, a causal relationship between AF (cause) and dementia (effect) has also been claimed [ 7 ]. In addition to the potential contribution of AF-related clinical cerebrovascular accidents (CVAs), there are several additional mechanistic hypotheses sustaining a causal association, which holds true also in the absence of CVAs: hemodynamic mechanisms (e.g., reduced mean cerebral blood flow, beat-to-beat alterations resulting in distal hypoperfusion and/or hypertensive events), subclinical microembolic cerebral infarctions, subclinical cerebral microbleeds (favored by oral anticoagulation treatment), and impaired cerebrovascular reactivity [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association

et al. 2022

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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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Increased beat-to-beat variability of cerebral microcirculatory perfusion during atrial fibrillation: a near-infrared spectroscopy study

Cited by 24 publications

References 17 publications

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

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

Commentary: Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association

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