Objective: Our literature review aims to summarize what has been reported in the literature with the next steps of looking at Kaiser Permanente (KP) to better understand this association.

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disease that has been associated with an increased risk of cardiovascular diseases, including atrial fibrillation (AF). AF is the most common sustained cardiac arrhythmia, affecting millions of people worldwide. While studies have shown that PD patients have a higher incidence of AF compared to those without PD, adequate research on the association between these two conditions is still lacking.

Method: We used the PubMed search engine to search for “Parkinson’s disease and atrial fibrillation.”

Results: The pubmed search revealed publications from 2018-2021. The association between AF and PD was demonstrated from various perspectives by the following 4 studies. A large cohort study found an increased incidence of AF in younger age subgroups of PD. ^[1] They noted that cardiac noradrenergic denervation, common in PD patients, is one of the pathophysiologic explanations for the association. Furthermore, it identified a positive correlation between PD severity and prolonged atrial conduction time. The development of AF is closely linked to atrial conduction delay and the initiation of reentry.^[2] A prospective study used atrial electromechanical delay measurements from 12-lead EKGs to show prolonged atrial conduction times were associated with PD severity.^[3]

Non-motor symptoms are prevalent in PD. Autonomic nervous system (ANS) dysfunction, affecting 70-80% of patients, is one such feature. ^[4] Hong et al. (2019) notes that ANS dysfunction in PD contributes to the development of AF, particularly in the early stages. The study suggests that AF could be a potential premotor biomarker for PD.

However, one recent case control study rejected the hypothesis of an association between AF and PD. They found no significant difference in P-wave duration on EKG and AF risk core between PD patients and controls. ^[6]

Conclusion: Cardiovascular diseases are the leading cause of death in both the general US population and Parkinson’s disease patients. Investigating the link between these conditions can aid in early diagnosis and improve patient outcomes. Our next step is look at a value-based system like KP to assess if A fib is more prevalent in PD patients and if it leads to a poor outcome.

References: 1. Han, Seokmoon, et al. “Increased Atrial Fibrillation Risk in Parkinson’s Disease: A Nationwide Population‐based Study.” Annals of Clinical and Translational Neurology, vol. 8, no. 1, Jan. 2021, pp. 238–46. DOI.org (Crossref), https://doi.org/10.1002/acn3.51279.
2. Weijs, B., et al. “Clinical and Echocardiographic Correlates of Intra-Atrial Conduction Delay.” Europace, vol. 13, no. 12, Dec. 2011, pp. 1681–87. DOI.org (Crossref), https://doi.org/10.1093/europace/eur261.
3. Çanga, Yiğit, et al. “Assessment of Atrial Conduction Times in Patients with Newly Diagnosed Parkinson’s Disease.” Parkinson’s Disease, vol. 2018, July 2018, pp. 1–5. DOI.org (Crossref), https://doi.org/10.1155/2018/2916905.
4. Zesiewicz, Theresa A., et al. “Autonomic Nervous System Dysfunction in Parkinson’s Disease.” Current Treatment Options in Neurology, vol. 5, no. 2, Mar. 2003, pp. 149–60. PubMed, https://doi.org/10.1007/s11940-003-0005-0.
5. Hong, Chien-Tai, et al. “Association Between Parkinson’s Disease and Atrial Fibrillation: A Population-Based Study.” Frontiers in Neurology, vol. 10, Feb. 2019, p. 22. DOI.org (Crossref), https://doi.org/10.3389/fneur.2019.00022.
6. Alves, Mariana, et al. “Does Parkinson’s Disease Increase the Risk of Atrial Fibrillation? Insights From Electrocardiogram and Risk Scores From a Case-Control Study.” Frontiers in Neurology, vol. 12, 2021. Frontiers, https://www.frontiersin.org/articles/10.3389/fneur.2021.633900.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-parkinsons-disease-and-atrial-fibrillation-a-literature-review/