Catheter Ablation and Cognitive Impairment in Atrial Fibrillation

Rosman, Lindsey; Burg, Matthew M.; Lampert, Rachel

doi:10.1161/circep.119.007521

Cited by 2 publications

(1 citation statement)

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“…The sequelae of SCLs may include subtle neurocognitive impairment, which is in turn associated with an increased lifetime risk of cognitive impairment. Several aspects of the AF ablation may lead to acute cerebral injury and post-procedural cognitive dysfunction, for example, periprocedural thrombus, cerebral hypoperfusion, and anesthesia ( 42 ). Besides, catheters are a source of embolization, such as air embolization and carbonization, which may increase the risk of thromboembolic events, and lead to cognitive impairment ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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Effects of rhythm-control and rate-control strategies on cognitive function and dementia in atrial fibrillation: a systematic review and meta-analysis

Guo,

Liu,

Jia

et al. 2024

Age and Ageing

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Background Growing evidence suggests that atrial fibrillation (AF) is an independent risk factor for cognitive impairment and dementia, even in the absence of thromboembolic events and stroke. Whether rhythm-control therapy can protect cognitive function remains unclear. We aimed to evaluate the efficacy of rhythm-control strategies in patients with AF regarding cognitive function and dementia risk. Methods We systematically searched the PubMed, Embase and Cochrane Library databases for randomised clinical trials, cohort and case–control studies evaluating the associations between rhythm-control strategies and cognitive function outcomes up to May 2023. We assessed the risk of bias using the ROBINS-I and the Cochrane risk-of-bias tool. Both fixed- and random-effects models were used to create summary estimates of risk. Results We included a total of 14 studies involving 193,830 AF patients. In the pooled analysis, compared with rate-control, rhythm-control therapy was significantly associated with a lower risk of future dementia (hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.62–0.89; I2 = 62%). Among the rhythm-control strategies, AF ablation is a promising treatment that was related to significantly lower risks of overall dementia (HR 0.62; 95% CI 0.56–0.68; I2 = 42%), Alzheimer’s disease (HR 0.78; 95% CI 0.66–0.92; I2 = 0%) and vascular dementia (HR 0.58; 95% CI 0.42–0.80; I2 = 31%). Pooled results also showed that compared with patients without ablation, those who underwent AF ablation had significantly greater improvement in cognitive score (standardized mean difference (SMD) 0.85; 95% CI 0.30–1.40; P = 0.005; I2 = 76%). Conclusions Rhythm-control strategies, especially ablation, are effective in protecting cognitive function, reducing dementia risk and thus improving quality of life in AF patients.

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Catheter Ablation and Cognitive Impairment in Atrial Fibrillation

Cited by 2 publications

References 20 publications

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

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

Effects of rhythm-control and rate-control strategies on cognitive function and dementia in atrial fibrillation: a systematic review and meta-analysis

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