Treatment of atrial fibrillation (AF) includes 3 key strategies : 1. Prevention of stroke , 2 . Maintenance of sinus rhythm, and 3. Control of heart rate. Stroke is the complication of AF we fear most , and prevention is the key. The anticoagulation with warfarin and apixampani is particularly effective in the prevention of stroke in patients with AF. But the identification of appropriate patients receive anticoagulation is not an exact science, and the shape stroke risk CHADS2 ( congestive heart failure, Hypertension , Age ≥ 75, Diabetes mellitus , previous stroke or transient ischemic stroke) and CHA2DS2-VASc ( Vascular Disease , age 65-74 years , female gender ) have only modest predictive value . Unfortunately , the brain is not the only consequence of neurological AF. Cognitive impairment and the silent cerebral infarcts (SCIs) without clinical stroke have been reported in patients with AF. The Kilander al. Showed that AF associated with low cognitive function in elderly regardless stroke. Also, discount memory and atrophy of the hippocampus and identified a group of patients with AF without stroke and mean age 60 years. The Bunch et al . Demonstrated that the AF independently associated with Alzheimer s disease and other dementias , with greater risk for those who are ≤ 70 years. Also there is rapid wear of the Alzheimer s disease when AF. Population studies show that diabetes , a disease associated with an increased risk of stroke is an independent risk factor for AF, adding another variable that affects the nerve function . Although patients undergoing ablation ypsisychno stream AF reported to have a lower risk of death and dementia of them without catalysis , catalysis by itself associated with periprocedural strokes and for silent cerebral embolic lesions detected by magnetic resonance imaging (MRI) . Finally, the AF can be often asymptomatic , but again is a significant risk of stroke . Two studies in this issue of the Journal of the American College of Cardiology give another look at the impact of AF in smaller neurological problems. The Marfella And thou . , Reviewed the incidence of subclinical AF and its relationship with SCI and stroke in otherwise healthy diabetic patients over 60 years. Asymptomatic AF episodes were discovered using intermittent 48-hour Holter quarterly originally first year and annually thereafter for the next three years of monitoring. Was first brain MRI to evaluate the SCI. Overall, 465 of the 1,992 patients met the criteria. Patients who experienced a clinical AF during monitoring excluded and hence each AF in the control group was only found subclinical and from recordings of Holter. After a median follow-up 37 months , 176 of 465 diabetic patients had episodes silently AF ( group SAFE). The prevalence of SCI (61% instead of 29%; p
Posted on: Sun, 27 Oct 2013 15:43:03 +0000
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