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We used arterial spin labeling, blood oxygenation level-dependent functional MRI (BOLD-fMRI), and a breath-hold challenge to characterize alterations in 14 AF patients compared with 14 age-matched healthy controls. We also examined the changes after catheter ablation with pulmonary vein isolation (PVI) in a subset of patients. Compared with controls, AF patients exhibited widespread reductions in basal cerebral perfusion, including in brainstem regions involved in cardiorespiratory regulation, and a higher prevalence of periodic breathing during wakeful rest. During breath-hold challenge, the coupling between heart rate and BOLD signal changes (\u0394BOLD) was smaller in AF, whereas \u0394BOLD coupling with breath-by-breath O\n                  <jats:sub>2<\/jats:sub>\n                  -CO\n                  <jats:sub>2<\/jats:sub>\n                  exchange ratio was greater at rest within pontine respiratory centers, indicating altered cardiac and respiratory contributions to cerebral hemodynamic regulation. Follow-up MRI scans 1-6 months after PVI demonstrated that restoration of sinus rhythm was associated with stronger heart rate-\u0394BOLD coupling during breath-hold challenge, whereas basal cerebral perfusion showed no significant change. This dissociation suggests distinct temporal responses of neuro-cardiorespiratory coupling and cerebral perfusion after sinus rhythm restoration, while the timing of cerebral perfusion recovery remains unresolved.\n                <\/jats:p>","DOI":"10.64898\/2026.07.08.26357304","type":"posted-content","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T20:40:14Z","timestamp":1783975214000},"source":"Crossref","is-referenced-by-count":0,"title":["Cerebral hypoperfusion and altered neuro-cardiorespiratory coupling in atrial fibrillation"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6627-3173","authenticated-orcid":false,"given":"Suk-tak","family":"Chan","sequence":"first","affiliation":[{"name":"Athinoula A. 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