Cognitive impairment in heart failure patients: role of atrial fibrillation.

Author's reply

We read with great interest the letter of Yiginer, et al.[1] regarding the influence of atrial fibrillation (AF) in the development of cognitive impairment in heart failure (HF) patients. The comment is related to the review published in the Journal by Leto, et al.[2] that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.[1] underlined as AF, declining the cerebral perfusion due to risk of thromboembolism, seemed to be one of the most evident cause of cognitive dysfunction in the elderly population. We agree completely with the comment, considering the experience of Gaita, et al.[3] on 180 atrial fibrillation patients (without HF) in which in 90% an area of silent cerebral ischemia at MR imaging was revealed and cognitive performance resulted to be worse in AF patients than in subjects with sinus rhythm. The major finding of this clinical experience was that AF patients with persistent or paroxysmal AF had a higher prevalence of silent cerebral ischemia and that might determine a worse cognitive performance. In conclusion, physicians who treat HF patients should be very careful in the presence of AF, reducing the risk of thromboembolism with anticoagulation therapy, avoiding the silent cerebral ischemia and the consequence in cognitive impairment.