Radiofrequency and cryoballoon ablation improve cognitive function in patients with atrial fibrillation

Wang, Xinlu; Wang, Zefeng; Yan, Xiaohan; Huang, Manyun; Wu, Yongquan

doi:10.1097/md.0000000000026914

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…The study scores ranged from 6/9–9/9. The cohort studies [ 14 – 19 ] presented suitable cohort comparability and outcome assessments, though often failed to demonstrate that the outcome of interest (dementia or impaired cognitive function) was not present at the start of the study. Jin et al fulfilled all domains appropriately [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

Bodagh

Yap

Kotadia

et al. 2022

J Interv Card Electrophysiol

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Purpose Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether the restoration of sinus rhythm with catheter ablation may modify this risk. We conducted a systematic review of studies comparing cognitive outcomes following catheter ablation with medical therapy (rate and/or rhythm control) in atrial fibrillation. Methods Searches were performed on the following databases from their inception to 17 October 2021: PubMed, OVID Medline, Embase and Cochrane Library. The inclusion criteria comprised studies comparing catheter ablation against medical therapy (rate and/or rhythm control in conjunction with anticoagulation where appropriate) which included cognitive assessment and/or a diagnosis of dementia as an outcome. Results A total of 599 records were screened. Ten studies including 15,886 patients treated with catheter ablation and 42,684 patients treated with medical therapy were included. Studies which compared the impact of catheter ablation versus medical therapy on quantitative assessments of cognitive function yielded conflicting results. In studies, examining new onset dementia during follow-up, catheter ablation was associated with a lower risk of subsequent dementia diagnosis compared to medical therapy (hazard ratio: 0.60 (95% confidence interval 0.42–0.88, p < 0.05)). Conclusion The accumulating evidence linking atrial fibrillation with cognitive impairment warrants the design of atrial fibrillation treatment strategies aimed at minimising cognitive decline. However, the impact of catheter ablation and atrial fibrillation medical therapy on cognitive decline is currently uncertain. Future studies investigating atrial fibrillation treatment strategies should include cognitive outcomes as important clinical endpoints.

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Section: Resultsmentioning

confidence: 99%

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

Bodagh

Yap

Kotadia

et al. 2022

J Interv Card Electrophysiol

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“…In this systematic review and meta-analysis, 4 studies ( 24 – 27 ) were retrospective cohort studies and 9 ( 28 – 36 ) were controlled clinical trials. Six studies ( 26 , 30 – 32 , 34 , 35 ) were conducted in China, 2 ( 24 , 29 ) in South Korean, 2 ( 25 , 27 ) in the United States, 1 ( 28 ) in Germany, 1 ( 36 ) in Japan, and 1 ( 33 ) in Australia. Four studies ( 24 – 27 ) reported the incidence of new-onset dementia, 4 ( 28 – 31 ) reported the changes in MoCA score, 3 ( 28 , 35 , 36 ) reported the MMSE score, 1 ( 32 ) reported the TICS-m score, and 2 ( 33 , 34 ) reported the incidence of POCD.…”

Section: Resultsmentioning

confidence: 99%

“…A small prospective study enrolling 23 patients showed worse neuropsychological outcomes in verbal memory in the AF ablation group ( 37 ). Previously, new SCLs detected after CA were a common occurrence in magnetic resonance imaging (MRI) of the brain and were reported in 4.3–38.9% of patients ( 32 , 38 , 39 ). However, during MRI follow-up of more than 90% of patients 1 year after AF ablation, SCLs had been proven to be resolved ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

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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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“…The following supporting information can be downloaded at: , Study selection; Data extraction; Table S1 : PRISMA 2020 checklist; Table S2 : Newcastle-Ottawa quality assessment scale table for cohort studies. [ 17 , 18 , 21 , 46 , 47 , 48 ] are cited in the Supplementary Materials .…”

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confidence: 99%

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

Ballatore

Xhakupi

et al. 2022

JCDD

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Background: Atrial fibrillation (AF) is independently associated with the onset of cognitive decline/dementia. AF catheter ablation (AFCA) is the most effective treatment strategy in terms of sinus rhythm maintenance, but its effects on dementia prevention remain under investigation. The aim of the present study was to perform a systematic review and meta-analysis of the presently available studies exploring the effect of AFCA on dementia occurrence. Methods: PubMed/MEDLINE databases were screened for articles through 14 March 2022 reporting adjusted time-to-event outcome data comparing AFCA and non-AFCA cohorts in terms of de novo dementia occurrence. A random effect meta-analysis was performed to estimate the meta-analytic hazard ratio (HR) of dementia occurrence in AFCA vs. non-AFCA cohorts, as well as the meta-analytic incidence rate of dementia in the non-AFCA cohort. Based on the aforementioned estimates, the number needed to treat (NNT), projected at median follow-up, was derived. Results: Four observational studies were included in the analysis, encompassing 40,146 patients (11,312 in the AFCA cohort; 28,834 in the non-AFCA cohort). AFCA conferred a significant protection to the development of dementia with an overall HR of 0.52 (95% CI 0.35–0.76). The incidence rate of dementia in the non-AFCA group was 1.12 events per 100 person-year (95% CI 0.47–2.67). The derived NNT projected to the median follow-up (4.5 years) was 41. Conclusion: AFCA is associated with a nearly 50% reduction in dementia occurrence during a median 4.5-year follow-up. Future randomized clinical trials are needed to reinforce these findings.

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Radiofrequency and cryoballoon ablation improve cognitive function in patients with atrial fibrillation

Cited by 9 publications

References 27 publications

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

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

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

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