Preserve the Brain

JACC: 8/6/13

Primary Goal in the Therapy of Atrial Fibrillation^∗

Treatment of atrial fibrillation (AF) involves 3 major strategies: prevention of stroke, maintenance of sinus rhythm, and rate control 1. Stroke is the most dreaded complication of AF, and its prevention is key. Anticoagulation with warfarin and the newer agents dabigatran, rivaroxaban, and apixaban is highly effective in preventing strokes in patients with AF (1,2,3,4). However, defining the appropriate patient for anticoagulant therapy is not an exact science, and the stroke risk schema CHADS₂ (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) and CHA₂DS₂-VASc (Vascular disease, Age 65–74 years, [female] Sex category) have only modest predictive ability 5. Unfortunately, stroke is not the only neurological consequence of AF. Cognitive impairment and silent cerebral infarcts (SCIs) without clinical strokes have been reported in patients with AF. Kilander et al. (6) showed that AF was associated with low cognitive function in elderly men independent of stroke. Further, memory impairment and hippocampal atrophy were identified in a group of stroke-free patients with AF and a mean age of 60 years 7.  Read more