YNIMG Journal 2025 Journal Article
Atrial fibrillation reduces CSF flow dynamics. A multimodal MRI study
- Sabine Hofer
- Marlena Schnieder
- Leonie Polster
- Peter Dechent
- Mathias Bähr
BACKGROUND: Atrial fibrillation (AF), the most common cardiac arrhythmia, is linked to cognitive impairment and dementia but the mechanisms behind are not understood. In the brain, the glymphatic system (GS) is crucial for clearing waste from the brain through rhythmic flow of CSF. In order to ensure optimal GS function a synchrony between the dynamics of blood flow and cerebrospinal fluid (CSF) flow is necessary. Thus, our aim was to examine GS function in AF using a fast multimodal imaging protocol in a single MRI session. METHODS: We measured 13 healthy volunteers and 13 patients with AF, using a 3T MRI system. To capture CSF and blood flow, real-time phase-contrast flow MRI was employed in the aqueduct, internal carotid artery, and jugular vein. T1-weighted imaging segmented brain tissue and ventricular size, while fast T1Flash examined tissue anatomy. EPI diffusion assessed fluid motion along the perivascular space, and artefact-free STEAM diffusion described whole-brain CSF dynamics. RESULTS: The results showed that AF patients had reduced and aperiodic CSF flow compared to healthy controls, with lower flow volume and less periodic flow patterns. Anatomical parameters such as brain volume, ventricular size, white matter integrity, and perivascular fluid flow showed no significant differences between the groups. CONCLUSIONS: These findings suggest that AF changes CSF dynamics and disrupts its rhythmicity, likely impairing GS function.