Association of Catheter Ablation and Reduced Incidence of Dementia among Patients with Atrial Fibrillation during Long-Term Follow-Up: A Systematic Review and Meta-Analysis of Observational Studies

Saglietto, Andrea; Ballatore, Andrea; Xhakupi, Henri; Ferrari, Gaetano Maria De; Anselmino, Matteo

doi:10.3390/jcdd9050140

Cited by 8 publications

(6 citation statements)

References 45 publications

(54 reference statements)

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“…Two previous meta-analyses also examined the relationship between AF ablation and dementia. A meta-analysis of 4 studies by Saglietto et al ( 48 ) showed that AF ablation is associated with a nearly 50% reduction in dementia occurrence. Another meta-analysis by Bodagh et al ( 49 ) found that AF ablation was associated with a lower risk of subsequent dementia diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation and cognitive function in atrial fibrillation: A systematic review and meta-analysis

Chen

Pan

et al. 2022

Front. Neurol.

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BackgroundAtrial fibrillation (AF) is a risk factor for cognitive dysfunction. Although catheter ablation (CA) is one of the main treatments for AF, whether it can improve cognitive function in patients with AF remains unclear. We conducted a systematic review and meta-analysis to evaluate the cognitive outcome post-CA procedure.MethodsTwo investigators independently searched the PubMed, EMBASE, Web of Science, CNKI, WanFang, and VIP databases from inception to September 2021 for all the potentially eligible studies. The outcomes of interest included dementia or cognitive disorder through scoring or recognized classification criteria. Heterogeneity was determined by using Cochrane's Q test and calculating the I2. A random-effects model was used to incorporate the potential effects of heterogeneity. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence.ResultThirteen studies including 40,868 patients were included, among which 12,086 patients received AF ablation. Meta-analysis indicated that patients with AF ablation had a lower risk of dementia incidence in comparison to patients with AF without ablation [hazard ratio (HR): 0.60, 95% CI: 0.43 to 0.84, p = 0.003 I2 = 40%]. Significant differences were observed in the incidence of new-onset dementia [risk ratio (RR): 0.43, 95% CI: 0.28 to 0.65, p < 0.0001 I2 = 84%]; the changes in the Montreal Cognitive Assessment (MoCA) score [weighted mean difference (WMD): 1.00, 95% CI: 0.36 to 1.64, p < 0.005 I2 = 0%] and Mini-Mental State Examination (MMSE) score (WMD: 0.98, 95% CI: 0.69 to 1.26, p < 0.00001 I2 = 0%]. However, in subgroup analysis, we did not observe significant changes in MoCA score at < 3 months (WMD: 1.20, 95% CI: −0.19 to 2.58, p = 0.09 I2 = 50%) and changes in cognitive function scores between the radiofrequency group and cryoballoon group [standard mean difference (SMD): 0.39, 95% CI: −0.47 to 1.24, p = 0.38 I2 = 87%]. The NOS indicated that included studies were moderate to high quality, while the quality of evidence assessed by GRADE was low in 2 and very low in 2.ConclusionWe analyzed the related cognitive outcomes after AF ablation. In the overall population, AF ablation had a positive trend for improving cognitive function at >3 months post-procedure. However, AF ablation might not be related to the improvement of cognitive function at < 3 months.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285198.

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Section: Discussionmentioning

confidence: 99%

Catheter ablation and cognitive function in atrial fibrillation: A systematic review and meta-analysis

Chen

Pan

et al. 2022

Front. Neurol.

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“…This procedure was associated with greater arrhythmia-free survival (RR 0.62, 95% CI 0.51–0.74, p < 0.001) and less hospitalizations (RR 0.32, 95% CI 0.19–0.53, p < 0.001) compared to AADs in a recent meta-analysis [ 34 ]. Other than the effectiveness in reducing major endpoints, a reduced risk of incident dementia with AF CA was proposed by Saglietto et al in their systematic review and meta-analysis [ 35 ]. Moreover, it may also prevent the progression of paroxysmal to persistent AF [ 36 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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“…Un reciente metaanálisis de cuatro estudios observacionales con un seguimiento medio de 4,5 años establece que la ablación mediante catéter en comparación con la no ablación confiere una protección significativa frente a la aparición de demencia, y el riesgo se reduce en algo más del 50% [ 40 ].…”

Section: Efectos Del Tratamiento De La Fibrilación Auricular En El De...unclassified

Fibrilación auricular y deterioro cognitivo: una revisión narrativa

Morales-Bacas¹,

Duque-Holguera²,

Portilla-Cuenca³

et al. 2022

RevNeurol

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Introducción. La fibrilación auricular (FA) es la arritmia más común en la práctica clínica y su incidencia y prevalencia aumentan con la edad, como ocurre con el deterioro cognitivo (DC). Desarrollo. Estudios observacionales prospectivos han demostrado que la FA puede aumentar significativamente el riesgo de sufrir un ictus, y éste es una causa importante de DC, pero también se ha establecido que la asociación entre ambas enfermedades puede ser independiente del ictus y otros factores de riesgo compartidos. Sin embargo, el mecanismo fisiopatológico que relaciona ambas entidades todavía no se conoce con exactitud, ya que es probable que se trate de un proceso multifactorial (ictus silentes cardioembólicos, estados proinflamatorios e hipoperfusión cerebral), y existe evidencia preliminar de una relación entre la miocardiopatía auricular sin FA y la disfunción cognitiva. La asociación entre FA y DC plantea la posibilidad de que las intervenciones terapéuticas dirigidas al manejo de esta arritmia puedan prevenir o retrasar la aparición del DC. La anticoagulación ha demostrado reducir de forma significativa el riesgo de ictus en pacientes con FA y, con ello, el riesgo de DC, pero el efecto de otras intervenciones terapéuticas, como el control del ritmo y de la frecuencia, no es concluyente. Conclusiones. La FA y el DC constituyen un importante problema de salud a nivel mundial, y la tendencia demográfica augura el crecimiento exponencial de ambas entidades en los próximos años. Por ello, parece necesario ampliar el conocimiento respecto a los mecanismos fisiopatológicos que las relacionan con el objetivo de establecer estrategias preventivas eficaces.

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Association of Catheter Ablation and Reduced Incidence of Dementia among Patients with Atrial Fibrillation during Long-Term Follow-Up: A Systematic Review and Meta-Analysis of Observational Studies

Cited by 8 publications

References 45 publications

Catheter ablation and cognitive function in atrial fibrillation: A systematic review and meta-analysis

Catheter ablation and cognitive function in atrial fibrillation: A systematic review and meta-analysis

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Fibrilación auricular y deterioro cognitivo: una revisión narrativa

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