To What Extent Does Heart Rate Alter the Cerebral Hemodynamic Patterns During Atrial Fibrillation

Abstract

Atrial fibrillation (AF), the most common cardiac arrhythmia leading to irregular and faster heartbeat, has been recently and independently associated to the risk of dementia. A constellation of hemodynamic mechanisms has been proposed to explain the possible link between the two pathologies. However, definitive data still miss, and it is unknown how heart rate (HR) influences the cerebral microcirculation. We propose a computational approach, based on a validated hemodynamic modeling, to compare the cerebral circulation during normal sinus rhythm (NSR) and AF at different HRs. AF is able to trigger a higher variability of the cerebral blood flow variables which grows towards the distal circulation. The alteration of the hemodynamic patterns, inducing the rupture of the signal periodicity and the consequent higher occurrence of extremely high/low values, increases with HR. Awaiting necessary clinical evidences, present findings highlight that a strict rate control strategy could be beneficial in terms of cognitive outcomes in patients with permanent AF.