Melissa E. Middeldorp, MPH, PhD, University of Adelaide is joined by Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide and Jared Bunch, MD, FHRS, University of Utah School of Medicine, to discuss a study that investigated the relationship between atrial fibrillation (AF), brain glymphatic function, and cognitive performance. Using MRI-derived diffusion tensor imaging along the perivascular space (DTI-ALPS), the authors found that patients with AF especially those with no paroxysmal AF exhibited impaired glymphatic activity compared to healthy controls. This reduced glymphatic function was associated with poorer cognitive performance in domains like attention and executive function, and mediation analyses suggested that glymphatic dysfunction partially explains the link between AF and cognitive decline. Notably, in patients who underwent catheter ablation to restore sinus rhythm, glymphatic function significantly improved post-procedure. These findings highlight a novel mechanistic pathway beyond stroke or vascular risk by which AF may contribute to neurodegeneration, and they suggest that rhythm control could offer protective benefits for brain health.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/eurheartj/article/46/18/1733/8029578

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

J. Dziano:

Nothing to disclose.

J. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc., Heart Rhythm Society