Association Between Atrial Fibrillation and Silent Cerebral Infarctions

Abstract

Background Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined. Purpose To estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF. Data Sources Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE from inception to 8 May 2014 without language restrictions and manual screening of article references. Study Selection Observational studies involving adults with AF and no clinical history of stroke or prosthetic valves who reported SCIs. Data Extraction Study characteristics and study quality were assessed in duplicate. Data Synthesis Eleven studies including 5317 patients with mean ages from 50.0 to 83.6 years reported on the association between AF and SCIs. Autopsy studies were heterogeneous and low-quality; therefore, they were excluded from the meta-analysis of the risk estimates. When computed tomography (CT) and magnetic resonance imaging (MRI) studies were combined, AF was associated with SCIs in patients with no history of symptomatic stroke (odds ratio, 2.62 [95% CI, 1.81 to 3.80]; I2 = 32.12%; P for heterogeneity = 0.118). This association was independent of AF type (paroxysmal vs. persistent). The results were not altered significantly when the analysis was restricted to studies that met at least 70% of the maximum possible quality score (odds ratio, 3.06 [CI, 2.24 to 4.19]). Seventeen studies reported the prevalence of SCIs. The overall prevalence of SCI lesions on MRI and CT among patients with AF was 40% and 22%, respectively. Limitation Most studies were cross-sectional, and autopsy studies were heterogeneous and not sufficiently sensitive to detect small lesions. Conclusion Atrial fibrillation is associated with more than a 2-fold increase in the odds for SCI. Primary Funding Source Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital.

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

“…AF is associated with significant morbidity,3, 4, 5 increased mortality,6 and increasing healthcare costs, making it a major public health challenge and socioeconomic burden 7. Hospitalizations related to AF increased >2.4‐fold from 1985 to 1999,8 and by an additional 23% in the past decade,9 contributing to the increasing costs associated with AF over the years.…”

Silent Cerebral Infarction in East Asian vs. Non-Asian Atrial Fibrillation Patients ― Meta-Analysis ―

“…In a recent meta-analysis, AF was associated with a more than 2-fold increased risk for SCI. 6 Several studies have reported an association between AF and increased risk of SCI in East Asian countries, 7-10 with the presence of SCI predicting subsequent clinically overt stroke. Thus, the prevalence of SCI and its effect as a risk factor for overt stroke are important considerations during the evaluation of AF.…”

Links between parameters of long-term latent memory and progression from paroxysmal to permanent atrial fibrillation during a five-year observation period. A preliminary study

“…It is associated with greater risk of both cardiological and non-cardiological complications, including a decrease in health-related quality of life, cardiac failure, stroke, and death [1,2]. This type of arrhythmia is also related to cognitive impairment [3][4][5][6][7][8]. This form of mental disorder may appear in patients both with organic lesions on neuroradiological brain examination (indicative of, for example, ischaemic stroke, silent cerebral ischaemia, silent brain infarct, damage in the blood vessels of the brain, white matter lesions, or loss of cortical, subcortical, or hippocampal volume) and without [6,[9][10][11][12].…”

“…This type of arrhythmia is also related to cognitive impairment [3][4][5][6][7][8]. This form of mental disorder may appear in patients both with organic lesions on neuroradiological brain examination (indicative of, for example, ischaemic stroke, silent cerebral ischaemia, silent brain infarct, damage in the blood vessels of the brain, white matter lesions, or loss of cortical, subcortical, or hippocampal volume) and without [6,[9][10][11][12]. The following pathomechanisms of the relationships between AF and cognitive impairment have been suggested: (a) stroke due to embolus of a cerebral artery; (b) asymptomatic cerebral artery microembolism with mate-rial of cardiac origin, e.g.…”