Subtle Post-Procedural Cognitive Dysfunction Following Atrial Fibrillation Ablation
Does radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) cause cognitive dysfunction (CD)?
Neuropsychological testing was performed in 90 patients (mean age 56 years) undergoing AF ablation, 30 patients (mean age 56 years) undergoing RFCA of supraventricular tachycardia (SVT), and a matched control group of 30 patients (mean age 53 years) awaiting an AF ablation procedure. The mean CHADS2 scores were similar (0.6-0.75) in all groups. RFCA was performed with an irrigated-tip catheter. Neuropsychological testing was performed at baseline and 2 days and 3 months post-ablation and at the same time points in the control group. All AF patients had an activated clotting time of 300-350 seconds during the ablation procedure and were anticoagulated for ≥3 months post-ablation.
New CD was present 2 days post-ablation in 28% of AF patients and 13% of SVT patients. At 3 months, post-ablation CD was present in 16% of AF patients and 3% of SVT patients. No new CD was found at 48 hours or 3 months post-baseline testing in the control group. The duration of left atrial access correlated with post-ablation CD.
The authors concluded that persistent CD is present in approximately 15% of patients after RFCA of AF using an irrigated-tip catheter.
Although the risk of stroke/transient ischemic events during RFCA of AF is only 0.5-1%, recent studies have demonstrated a 7-14% prevalence of silent cerebral infarctions after ablation using an irrigated-tip catheter. Because magnetic resonance imaging (MRI) of the brain was not performed in the present study, it is unclear whether the CD correlated with silent cerebral infarctions. A large proportion of MRI lesions resolve during long-term follow-up, but whether CD improves or worsens over time is unknown.
Keywords: Cognition, Tachycardia, Supraventricular, Catheter Ablation
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