Association of Atrial Fibrillation With White Matter Disease

Abstract

Background and Purpose— Evidence suggests that atrial fibrillation (AF) is associated with increased risk of cognitive decline and dementia, even in the absence of stroke. White matter disease (WMD) is a potential mechanism linking AF to cognitive impairment. In this study, we explored the association between prevalent AF and WMD. Methods— We performed a cross-sectional analysis of participants attending the ARIC-NCS (Atherosclerosis Risk in Communities–Neurocognitive Study) in 2011 to 2013 who underwent brain magnetic resonance imaging. AF was ascertained from study visit electrocardiograms or prior hospitalization codes. Extent of WMD was defined by measures of white matter (WM) microstructural integrity and WM hyperintensity volume. Multivariable linear regression models were used to assess the association between AF and WMD. Results— Among 1899 participants (mean age, 76 years; 28% black; 60% women), 133 (7%) had prevalent AF. After multivariable adjustment, differences between participants with and without AF were −0.001 (95% CI, −0.006 to 0.004) for global WM fractional anisotropy, 0.031×10 −4 mm 2 /s (95% CI, −0.075 to 0.137) for global WM mean diffusivity, and 0.08 mm 3 (95% CI, −0.14 to 0.30) for WM hyperintensity volume. Conclusions— The results suggest that there is no association between prevalent AF and WMD.

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

“…485 Although white matter disease had been raised as another potential driver, recent work appears to refute this. 482,486,487 Treatments that have been proposed to reduce the risk of cognitive impairment include risk factor management, 488 sinus rhythm maintenance with ablation, 489 and anticoagulation. [490][491][492] A modest effect has been observed with specific risk factor treatments, such as statins or angiotensin conversion enzyme inhibitor and angiotensin receptor blocker therapy in some studies, 481,488 but not in others.…”

Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi‐Ethnic Study of Atherosclerosis

“…A previous report that examined clinically detected AF in relation to total WM FA reported no association. 26 Several studies have reported no association of AF with WMH volume 26 , 27 , 28 , 29 or with cortical and lobar microhemorrhages. 29 In the present study, greater spatial resolution and automated digital image analysis methodology may have offered greater precision in MRI measures and supplementing clinical AF with extended ambulatory monitoring more accurately classified AF.…”

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

“…Adverse effects of AF on cerebral small vessel disease may be one mechanism by which AF contributes to cognitive impairment. However, several studies failed to demonstrate an association between AF and WMHs [ 28 , 47 , 48 ]. Of note, a cross-sectional analysis of the community-based Framingham Heart Study did not report any associations between AF and lower total brain volume [ 7 ].…”

“…Incident AF is associated with structural changes in brain MRI, including worsened sulcal grade, larger ventricles, and subclinical cerebral infarctions. However, analyses from the ARIC and the Framingham Heart Study could not demonstrate any association between AF and WMHs or total brain volume after adjustment for vascular risk factors [ 39 , 47 , 49 ]. Notably, WMHs, attributed to small vessel disease and global cerebral hypoperfusion, were not associated with AF [ 49 ].…”