Researchers say it’s critical for medical professionals to look for biomarkers of brain injury in people with AFib.
Patients with an abnormal heartbeat also show signs of silent brain injury.
That’s according to a study recently presented at the American Heart Association’s Scientific Sessions in Chicago.
Researchers say they found that patients with atrial fibrillation can experience chronic injury to the brain that may not be obvious through symptoms.
The findings could have important implications in identifying patients at risk of neurodegenerative problems such as dementia and cognitive decline.
“Atrial fibrillation is the most common sustained abnormal heart rhythm and will impact 30 to 40 percent of our aging population. Dementia is strongly associated with atrial fibrillation and is becoming a leading cause of death and disability worldwide. Atrial fibrillation patients develop dementia earlier and the progression is more rapid. How we identify and treat atrial fibrillation can impact dementia risk,” Dr. Jared Bunch, co-author of the study and medical director of Heart Rhythm Services for Intermountain Healthcare, told Healthline.
Bunch and his colleagues from the Intermountain Medical Center Heart Institute, Salt Lake City examined 246 patients.
Of them, 198 had atrial fibrillation and 48 didn’t.
The researchers obtained plasma samples from the participants and tested them for four different biomarkers that are associated with brain injury.
Of the four biomarkers tested, they found that three of them were notably higher in patients who had atrial fibrillation.
The researchers say it’s crucial to identify these early indications of brain injury.
They say if patients are experiencing ongoing injury of this kind, they are at higher risk of developing depression and neurodegeneration, such as dementia and cognitive decline.
“Biomarkers are critical to identify patients at risk of developing dementia. Biomarkers are also critical to understand the global brain and potential injuries that occur that may not be detected by our routine brain scans or cognitive testing. With more specific tools, we can better identify our therapies for atrial fibrillation to improve stroke and dementia rates,” Bunch said.
Atrial fibrillation, also referred to as AFib, is the most common form of heart arrhythmia.
Arrhythmia occurs when the heart beats too slowly, too quickly, or in an irregular rhythm.
For some people, atrial fibrillation may be an ongoing, permanent condition, while for others, the condition occurs in brief stints.
According to the Centers for Disease Control and Prevention (CDC), between 2.7 and 6.1 million people in the United States have atrial fibrillation.
The number of cases of atrial fibrillation increases with age.
Some patients don’t experience any symptoms while others can experience problems such as heart palpitations, fatigue, shortness of breath, and chest pain.
It’s estimated that 750,000 hospitalizations and 130,000 deaths annually can be attributed to atrial fibrillation.
The condition can lead to strokes, blood clots, heart failure, and other cardiac problems.
“In addition to stroke, which is the fourth to fifth most common cause of mortality, atrial fibrillation may be associated with vascular dementia, thought to be as common as Alzheimer’s disease, so a major problem,” Dr. Gordon Tomaselli, a professor of cardiology at the Albert Einstein College of Medicine in New York, told Healthline.
Atrial fibrillation can also have an impact on the brain.
“Atrial fibrillation impacts brain function through many different pathways. First, we recognize that atrial fibrillation is a common cause of large and disabling strokes. Second, our use of anticoagulants to minimize stroke risk can cause brain bleeds. One mechanism of dementia is that it is a spectrum of these types of injuries in that it represents many small strokes or bleeds that in aggregate negatively impact brain function,” Bunch told Healthline.
“Atrial fibrillation creates an abnormal heart rate and rhythm and that causes beat-by-beat differences in blood flow to the brain,” he added. “Dementia rates are lower when the heart rate is carefully controlled to avoid long pauses, or the rhythm is restored with ablation. We have also found that there exists a genetic tendency in some people that have gene mutations that are associated with the early development of atrial fibrillation or stroke.”
Because atrial fibrillation alters the way blood flows through the body, it can disrupt the blood-brain barrier, a membrane that separates blood from cerebrospinal fluid, and filters blood coming in and out of the brain and spinal cord.
If it isn’t working as it should, neuro-specific molecules can get into the bloodstream.
The research by Intermountain Medical Center is part of a growing body of research that suggests a link between atrial fibrillation and brain injury.
A Swiss study that performed MRIs on patients with atrial fibrillation found that 41 percent had signs of at least one form of silent brain damage.
“There is some emerging evidence that controlling the heart rhythm, that is, trying to eliminate AF and get patients back into a normal heart rhythm, may reduce some of the more common neurological problems,” Tomaselli said.
But this may be easier said than done.
“Depending upon the circumstances, it may be very difficult to get patients back into normal rhythm and keep them there,” he said.
Bunch says there is a need for tools that can identify early risk of brain injury, that can be repeated during treatment or lifestyle changes to see if the risk has been adjusted.
“Biomarkers are effective tools in this regard. We have found that many can be used both in isolation and in combination to identify people with risk of cranial injury and progression towards dementia,” he said.
“We need to identify tools that can identify people early at risk of stroke and dementia and monitor that risk as they age, receive treatments, and make lifestyle changes,” Bunch added. “A panel of biomarkers can assist us as tools of risk assessment. We are in the process of creating these tools to assist clinicians as they manage people with atrial fibrillation.”
Patients with atrial fibrillation can experience chronic, asymptomatic brain injury.
Experts are in the process of creating tools to assist in identifying people at risk of neurodegenerative problems, such as dementia and cognitive decline.
They say these biomarkers are important so people with atrial fibrillation can get early treatment on silent brain injuries.