Pathophysiological mechanisms and therapeutic management of cognitive impairment in patients with atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most commonly occurring type of arrhythmia in clinical practice. Approximately one third of all rhythm abnormality admissions are due to atrial fibrillation. As we already know it increases risk of stroke, heart failure, cardiovascular diseases and sudden cardiac death. On the last two decades several reports have revealed the relation of AF to cognitive function, from slight disorders up to dimension. Ischemic stroke due to AF is a well known risk factor and predictor of cognitive impairment. In this case stroke risk can be reduced by taking anticoagulants. Nevertheless, last reports have showen that even if there isn't stroke in anamnesis, A.F can still be a predictor of cognitive disorders and dimension. Cerebral hypoperfusion, brain volume reduction, cerebral microbleeds, hyperintensity of the white matter, neuroinflammation and genetic factors are potential mechanisms in the pathogenesis of cognitive impairment in patients with Atrial Fibrillation. But that link is still a controversial issue (topic). Nowadays there are no strategies, that prevent cognitive disorders related to A.F in patients who didn't had stroke. In this review potential mechanisms that lead to cognitive dysfunction in patients with AF will be discussed and the influence of restoration and control of normal sinus rhythm on reducing cognitive disorder risk factors will be analyzed.