Evidence map›Paper›PMID 35061884›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2022

Predictive role of atrial fibrillation in cognitive decline: a systematic review and meta-analysis of 2.8 million individuals.

Yu Han Koh, Leslie Z W Lew, Kyle B Franke, Adrian D Elliott, Dennis H Lau, Anand Thiyagarajah, Dominik Linz, Margaret Arstall, Phillip J Tully, Bernhard T Baune and 2 more

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07008066 (Exercise-induced Cardioversion in Persistent Atrial Fibrillation), which is not on this map. Cited by 65 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed, 7 pooled it
15.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07008066 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Exercise-induced Cardioversion in Persistent Atrial Fibrillation (ExPAF): A Feasibility Pilot Study

TypeinterventionalSponsorUppsala UniversityRan2025 to 2026Enrolled60ConditionsAtrial Fibrillation (AF)ArmsBicycle ergometer excercise, Standard care with electrical cardioversion
3 · Its place in the literature

Who cites it

65 citing papers in PubMed, 7 syntheses or guidelines pooled it, 98 citations in OpenAlex.

  1. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  2. Management of brain-heart multimorbidity: a clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  3. Beyond the beats: a systematic review of the underlying inflammatory pathways between atrial fibrillation and cognitive decline.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Pooled it
  4. Pooled it
  5. Umbrella review and Delphi study on modifiable factors for dementia risk reduction.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024
    Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. A cardiovascular-motor axis framework for perfusion-mediated motor impairment.International journal of cardiology. Heart & vasculature · 2026
    Review
  10. Article
  11. Review
  12. Review
  13. Article
  14. Article
  15. Review
  16. Review
  17. Article
  18. Article
  19. Observational
  20. Review

5 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 4 institutions in 3 countries.

Yu Han KohThe University of Adelaide, Adelaide, Australia.
Leslie Z W LewThe University of Adelaide, Adelaide, Australia.ORCID 0000-0002-1474-5965
Kyle B FrankeThe University of Adelaide, Adelaide, Australia.ORCID 0000-0002-0710-406X
Adrian D ElliottThe University of Adelaide, Adelaide, Australia.
Dennis H LauThe University of Adelaide, Adelaide, Australia.ORCID 0000-0001-7753-1318
Anand ThiyagarajahRoyal Adelaide Hospital, Adelaide, Australia.
Dominik LinzThe University of Adelaide, Adelaide, Australia.ORCID 0000-0003-4893-0824
Margaret ArstallThe University of Adelaide, Adelaide, Australia.
Phillip J TullyThe University of Adelaide, Adelaide, Australia.
Bernhard T BauneDepartment of Psychiatry, University of Melbourne, Melbourne, Australia.
Dian A MunawarThe University of Adelaide, Adelaide, Australia.
Rajiv MahajanThe University of Adelaide, Adelaide, Australia.ORCID 0000-0003-3375-5568
The University of Adelaide · AURoyal Adelaide Hospital · AULyell McEwin Hospital · AUThe University of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo systematic review and meta-analyse the association and mechanistic links between atrial fibrillation (AF) and cognitive impairment. METHODS AND

resultsPubMed, EMBASE, and Cochrane Library were searched up to 27 March 2021 and yielded 4534 citations. After exclusions, 61 were analysed; 15 and 6 studies reported on the association of AF and cognitive impairment in the general population and post-stroke cohorts, respectively. Thirty-six studies reported on the neuro-pathological changes in patients with AF; of those, 13 reported on silent cerebral infarction (SCI) and 11 reported on cerebral microbleeds (CMB). Atrial fibrillation was associated with 39% increased risk of cognitive impairment in the general population [n = 15: 2 822 974 patients; hazard ratio = 1.39; 95% confidence interval (CI) 1.25-1.53, I2 = 90.3%; follow-up 3.8-25 years]. In the post-stroke cohort, AF was associated with a 2.70-fold increased risk of cognitive impairment [adjusted odds ratio (OR) 2.70; 95% CI 1.66-3.74, I2 = 0.0%; follow-up 0.25-3.78 years]. Atrial fibrillation was associated with cerebral small vessel disease, such as white matter hyperintensities and CMB (n = 8: 3698 patients; OR = 1.38; 95% CI 1.11-1.73, I2 = 0.0%), SCI (n = 13: 6188 patients; OR = 2.11; 95% CI 1.58-2.64, I2 = 0%), and decreased cerebral perfusion and cerebral volume even in the absence of clinical stroke.

conclusionAtrial fibrillation is associated with increased risk of cognitive impairment. The association with cerebral small vessel disease and cerebral atrophy secondary to cardioembolism and cerebral hypoperfusion may suggest a plausible link in the absence of clinical stroke. PROSPERO CRD42018109185.

Indexed as

Atrial FibrillationCerebral Small Vessel DiseasesCognitive DysfunctionStrokeHumansOdds RatioRisk FactorsAtrial fibrillationCerebral small vessel diseaseCognitive impairmentDementiaMeta-analysisSilent brain infarctionStroke

Identifiers

PMID35061884
PMCPMC9435641
OpenAlexW4205601971

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.