Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients With Impaired Cognitive Function

Abstract

Background: Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation improves or worsens cognitive function. This prospective case-control study sought to assess the 1-year serial changes in the cognitive function with or without AF catheter ablation. Methods: We evaluated the Montreal Cognitive Assessment score in 308 patients (71.4% male, 60.6±9.1 years of age, 34.1% persistent AF) who underwent AF ablation (ablation group) and 50 AF patients on medical therapy who met the same indication for AF ablation (control group), at baseline and 3 and 12 months after enrollment. Cognitive impairment was defined as a published cutoff score of <23 points. To exclude any learning effects, we used the practice-adjusted reliable change index for assessing the cognitive changes. Results: Preablation cognitive impairment was detected in 18.5% (57/308). The Montreal Cognitive Assessment score significantly improved 1 year after radiofrequency catheter ablation in both overall ablation group (24.9±2.9–26.4±2.5; P <0.001) and the propensity-matched ablation group (25.4±2.4–26.5±2.3; P <0.001), but not in the control group (25.4±2.5–24.8±2.5; P =0.012). Preablation cognitive impairment (odds ratio, 13.70; 95% CI, 4.83–38.87; P <0.001) was independently associated with an improvement in the 1-year post-ablation cognitive function. In the reliable change index analyses, 94.7% of propensity-matched ablation group showed an improved/stable cognitive function at the 1-year follow-up. Conclusions: Catheter ablation of AF, at least, does not deteriorate the cognitive function, but rather improves the performance on 1-year follow-up neurocognitive tests, especially in patients with a preablation cognitive impairment.

A mesh‐type flexible tip catheter vs a contact force catheter for catheter ablation of atrial fibrillation: A prospective nonrandomized 1:1 matched study

“…Well‐controlled sinus rhythm after AFCA has positive effects on the HF mortality, 1 stroke risk, 2,20 cognitive function, 4 and renal function 5 in patients with AF. However, it still poses a continuous risk for recurrence, even after AFCA 10 .…”

“…Catheter ablation of atrial fibrillation (AF) is an effective intervention for rhythm control and improves heart failure‐related mortality, 1 risk of a stroke, 2,3 cognitive function, 4 and renal function 5 . However, the long‐term AF recurrence rates after catheter ablation of atrial fibrillation (AFCA) remain substantial 6 .…”

Prevalence and Progression of Cognitive Impairment in Atrial Fibrillation Patients after Treatment with Catheter Ablation or Drug Therapy

“…Cognitive performance evaluated as a mean Short Blessed Test (SBT) score was found to be higher in patients with rhythm control than in rate control [41]. Recently, Jin et al showed in a prospective case control study that catheter ablation of AF at least does not deteriorate cognitive function but rather improves the performance in 1-year follow-up neurocognitive tests, especially in patients suffering from preablation cognitive impairment [18].…”

“…However, in the long term, it has been reported that AF ablation is associated with a lower risk of Alzheimer dementia [16]. Until today, no AF treatment has yet been linked to a prevalence of cognitive dysfunction and its development, as the few existing studies dealing with this topic revealed inconsistent results [7,[16][17][18].…”

Persistent atrial fibrillation over 3 years is associated with higher recurrence after catheter ablation

“…The aggressive rhythm control slows the AF progression, and the AF progression rate is 3.3‐fold lower in the rhythm‐control group than the rate control group 3,6 . Catheter ablation of AF is an effective rhythm control strategy that reduces the AF burden, heart failure mortality, 7 risks of a stroke, 8 and risk of cognitive dysfunction 9 …”