[Atrial fibrillation and impairment of cognition-importance for geriatrics]

Analysis of the Independent Risk Factors of second-Degree Atrioventricular Block in Patients with Atrial Fibrillation and the Diagnostic Efficacy of Dynamic Electrocardiogram

Objective

Exploring the independent risk factors of second-degree atrioventricular block (II AVB) in patients with atrial fibrillation (AF), and to evaluate the clinical value of 24-hour dynamic electrocardiogram (DCG) in its diagnosis.

Methods

A prospective cohort study was conducted on 947 patients with AF diagnosed and treated in our hospital from January 1, 2021 to December 31, 2021. These patients were divided into combined group (98 cases) and uncombined group (849 cases) according to whether they were accompanied by. The clinicopathological data of the patients were collected, and Multivariate logistic regression analysis was used to analyze the independent risk factors. Patients in combined group were further evenly divided into the study group (underwent 24-hour DCG) and the control group (underwent routine ECG) based on the detection methods. The diagnostic value was valued and the positive detection rate was calculated by ROC curve.

Results

The smoking history, left atrial internal diameter (LAD), R-R interval and ventricular rate of patients in two groups had significant differences (P<0.001). Smoking history (HR=1.531, 95% CI 1.150-2.038, P<0.001), LAD>35.88 mm (HR=1.941, 95% CI 1.301-2.895, P<0.001), R-R interval>2.50 s (HR=2.282, 95% CI 1.231-4.229, P=0.014) were independent risk factors for AF combined with II AVB, while ventricular rate≤70 beats/min (HR=0.506, 95% CI 0.293-0.873, P=0.014) were independent protective factors for AF combined with II AVB. The mean ventricular rate (70.03±5.40 beats/min vs 83.11±8.05 beats/min, P<0.001) and R-R interval (2.82±0.26s vs 2.37±0.14s, P<0.001) in the study group were longer than the control group. The diagnostic positive rate of DCG (97.96% vs 85.71%, χ²=4.900, P=0.027) was higher than that of conventional ECG.

Conclusion

Smoking history, LAD, R-R interval and ventricular rate were influential factors for AF combined with II AVB. 24-h DCG had potential diagnostic value in the occurrence of AF combined with II AVB.

Atrial cardiopathy and cognitive impairment

Cognitive impairment involves complex interactions between multiple pathways and mechanisms, one of which being cardiac disorders. Atrial cardiopathy (AC) is a structural and functional disorder of the left atrium that may be a substrate for other cardiac disorders such as atrial fibrillation (AF) and heart failure (HF). The association between AF and HF and cognitive decline is clear; however, the relationship between AC and cognition requires further investigation. Studies have shown that several markers of AC, such as increased brain natriuretic peptide and left atrial enlargement, are associated with an increased risk for cognitive impairment. The pathophysiology of cognitive decline in patients with AC is not yet well understood. Advancing our understanding of the relationship between AC and cognition may point to important treatable targets and inform future therapeutic advancements. This review presents our current understanding of the diagnosis of AC, as well as clinical characteristics and potential pathways involved in the association between AC and cognitive impairment.