Cardiac autonomic function and cognitive performance in patients with atrial fibrillation

Peter Hämmerle, Stefanie Aeschbacher, Anne Springer, Ceylan Eken, Michael Coslovsky, Gilles Dutilh, Giorgio Moschovitis, Nicolas Rodondi, Patricia Chocano, David Conen, Stefan Osswald, Michael Kühne, Christine S Zuern, Peter Hämmerle, Stefanie Aeschbacher, Anne Springer, Ceylan Eken, Michael Coslovsky, Gilles Dutilh, Giorgio Moschovitis, Nicolas Rodondi, Patricia Chocano, David Conen, Stefan Osswald, Michael Kühne, Christine S Zuern

Abstract

Background: Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients.

Methods: Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they had AF ("AF group") or sinus rhythm ("SR group") on a baseline 5 min ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), RMSSD, SDNN, total power and power in the VLF, LF, HF ranges) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function.

Results: 1685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. MoCA score was 24.5 ± 3.2 in the AF group (N = 710 patients) and 25.4 ± 3.2 in the SR group (N = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group [β = 0.049; 95% confidence interval (CI) 0.016-0.081; p = 0.003] and in the AF group (β = 0.068; 95% CI 0.020-0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β = - 0.008; 95% CI - 0.014 to - 0.002; p = 0.014). We found no convincing evidence of association for other CAF parameters with cognition.

Conclusion: Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Among standard HRV parameters, HRVI might be the most promising ECG index.

Trial registration: ClinicalTrials.gov Identifier: NCT02105844.

Keywords: Atrial fibrillation; Cardiac autonomic function; Heart rate variability; Montreal Cognitive Assessment; Neurocognitive function.

Conflict of interest statement

DC holds a McMaster University Department of Medicine Mid-Career Research Award. CMZ reports honoraria from Vifor Pharma and Novartis. GM has received consultant fees for taking part to advisory boards from Novartis, Boehringer Ingelheim, Bayer and Astra Zeneca, all outside of the submitted work. MK has received grants from the Swiss National Science Foundation, the Swiss Heart Foundation, Daiichi-Sankyo, Bayer, and Pfizer-BMS and lecture/consulting fees from Daiichi-Sankyo, Boehringer Ingelheim, Bayer, Pfizer-BMS, AstraZeneca, Sanofi-Aventis, Novartis, MSD, Medtronic, Boston Scientific, St. Jude Medical, Biotronik, Sorin, Zoll and Biosense Webster. NR has received a grant from the Swiss Heart Foundation. The remaining co-authors do not report conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of patient selection
Fig. 2
Fig. 2
Cognitive performance assessed by the MoCA
Fig. 3
Fig. 3
Interdependence of heart rate variability triangular index and cognitive impairment in the sinus rhythm group (left panel) and atrial fibrillation group (right panel)

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