Atrial fibrillation even anticoagulation, new cerebral infarction is still not uncommon!European Heart Journal study

2022-05-06 0 By

A prospective multicenter cohort study of atrial fibrillation (AF) published February 17 in the European Heart Journal (ECJ) showed that new and mostly occulent cerebral infarction was still common in patients with af even after anticoagulant therapy.Patients with new cerebral infarction had significantly reduced cognitive function.The findings support the notion that atrial fibrillation is a cause of vascular dementia and is primarily due to occult infarction, the researchers note.The study also suggests that for all patients with atrial fibrillation, anticoagulant therapy alone may not be sufficient to prevent brain damage and cognitive decline.It is not clear whether some patients may benefit from different, higher doses of anticoagulants or from the addition of antiplatelet agents, which must be weighed against the risk of major bleeding.Small ischaemic lacunar infarction may be primarily due to small vascular disease of the brain rather than cardiogenic thrombosis, and anticoagulant therapy may be less effective in such patients.In addition to antithrombotic therapy, early rhythm control improves outcomes in patients with atrial fibrillation, but it is unclear whether this approach can prevent occultation and cognitive decline.A total of 1227 patients with af were enrolled, with a mean age of 71 years, 26.1% were women, 89.9% were on anticoagulants, and 19.2% had a history of stroke or TRANSIENT ischemic attack.All patients underwent standardized mri of the brain at baseline and 2 years later.Occultation infarction was defined as a small noncortical infarction or a large noncortical or cortical infarction on MRI in patients without clinical stroke or TRANSIENT ischemic attack during follow-up.During the 2-year follow-up, 2.3% of patients had a stroke or transient ischemic attack.Mri showed that 5.5% (68 patients) had a new infarction (including 10 stroke patients), of whom 88.2% were on anticoagulants at baseline and 85.3% had occulent infarction;White matter lesions were reported in 18.7% of patients, and brain microbleeds were reported in 11.4% of patients.Compared with the control group, the cognitive function of patients with new cerebral infarction decreased significantly;Occultation infarction and symptomatic infarction have similar effects on cognitive function.However, emerging white matter lesions and brain microbleeds were not associated with cognitive decline.Further analysis showed that older age and a history of stroke or TIA were risk factors for occi.Recently, a study in the First Affiliated Hospital of Zhengzhou University said that 14% of patients had asymptomatic cerebral infarction after atrial fibrillation ablation.Patients who had a new asymptomatic cerebral infarction after surgery had a significantly higher incidence of ischemic stroke 1 year later (10.81% vs. 1.83%;OR=6.485), and the incidence of death and vascular cognitive impairment was also increased.Source:[1] Silent brain infarcts impact on cognitive function in atrial fibrillation. European Heart Journal, 17 February 2022[2] LU Wenjie, PAN Liang, WANG Xi, et al.Incidence and prognosis of new asymptomatic cerebral infarction after cryoballoon or radiofrequency catheter ablation of atrial fibrillation.China Circulation, 2021, 36:Many difficult and complex cases, a doctor can only see once in his lifetime:18656052587(wechat) or zgxhzz@vip.163.com Disclaimer: This article is reproduced for the purpose of passing on more information.If the source is wrong or violated your legitimate rights and interests, please contact the author with proof of ownership, we will promptly correct, delete, thank you.Email address: newmedia@xxcb.cn