Atrial fibrillation and the brain

Stroke is the second most common cause of death, and one of the most common sources of disability. Cardiac embolization, most frequently caused by atrial fibrillation, is identified in the background in almost one third of the cases. The detection of atrial fibrillation may have special significance from a therapeutic point of view as well, since anticoagulation, preferably with direct oral anticoagulants, is the first treatment of choice for secondary stroke prevention in that case. Beside or in addition to stroke, atrial fibrillation may evoke cognitive impairment as well via its negative impact on brain function, and thereby may have a significant negative influence on the quality of life. Regarding the pathomechanism, cerebral thromboembolism (including silent cerebral infarcts), hypoperfusion, and microbleeds may come into account, but inflammatory processes and genetic factors may have a role as well. This negative impact on cognitive functions may be substantially mitigated by cardiovascular risk reduction, anticoagulant treatment, and appropriate rhythm- and/or rate control.