Log in to MyACC
Less Dementia After Catheter Ablation for Atrial Fibrillation
Quick Takes
- There are conflicting data on the impact of AF ablation versus medical therapy on cognitive function and development of dementia.
- In a nationwide cohort, patients who underwent AF ablation had lower incidence and risk of overall dementia than those on medical therapy (8.1 and 5.6 per 1,000 person-years, respectively; hazard ratio, 0.73; 95% confidence interval, 0.58-0.93).
Study Questions:
What is the association of catheter ablation for atrial fibrillation (AF) with the occurrence of dementia?
Methods:
The authors used an administrative database of the National Health Insurance Service of Korea to identify adults with AF treated with ablation or medical therapy (antiarrhythmic or rate control drugs) between 2005 and 2015. The time-at-risk was counted from the first medical therapy, and ablation was analyzed as a time-varying exposure. Propensity score matching was used.
Results:
There were 194,928 newly diagnosed AF patients. After exclusions, the authors analyzed 9,119 patients who underwent AF ablation and 17, 978 patients who received medical therapy. Median follow-up was 52 months. Patients who underwent AF ablation had lower incidence and risk of overall dementia than those on medical therapy (8.1 and 5.6 per 1,000 person-years, respectively; hazard ratio, 0.73; 95% confidence interval, 0.58-0.93). There were consistent associations between AF ablation and dementia risk after censoring for incident stroke (hazard ratio, 0.76; 95% confidence interval, 0.61-0.95) and difference was more pronounced in cases of AF ablation success. Ablation was associated with lower risks of both Alzheimer’s disease and vascular dementia.
Conclusions:
Patients with AF who are treated with catheter ablation appear to have a decreased dementia risk than those on medical therapy.
Perspective:
AF is associated with an increased risk of dementia. Prior studies have reported both declining cognitive function and subclinical acute brain lesions on magnetic resonance imaging in patients undergoing AF ablation, and improvement of cognitive function and reduction in risk of dementia following ablation. The current study is an important addition, although it has many limitations related to the administrative database and inability to control for many potentially confounding variables, such as baseline cognitive function, quality of anticoagulation, and others. Since catheter ablation of AF prolongs the duration of sinus rhythm compared with medical therapy, it is conceivable that it may be associated with a healthier neurological milieu, translating into improved cognitive function. Controlled and preferably blinded clinical trials of AF ablation versus medical therapy along with fastidious neurocognitive testing and long follow-up would be required to provide the definitive answer.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Sleep Apnea
Keywords: Alzheimer Disease, Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Cognition, Dementia, Dementia, Vascular, Secondary Prevention, Stroke, Vascular Diseases
< Back to Listings
