Subtle Post-Procedural Cognitive Dysfunction Following Atrial Fibrillation Ablation

Study Questions:

Does radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) cause cognitive dysfunction (CD)?

Methods:

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.

Results:

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.

Conclusions:

The authors concluded that persistent CD is present in approximately 15% of patients after RFCA of AF using an irrigated-tip catheter.

Perspective:

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.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Cognition, Tachycardia, Supraventricular, Catheter Ablation


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