Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs

Zeitler, Emily P.; Bunch, T. Jared; Khanna, Rahul; Fan, Xiaozhou; Iglesias, Maximiliano; Russo, Andrea M.

doi:10.1016/j.ahj.2022.09.007

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…14 A US-based study of 38,176 patients with AF after propensity-score matching suggested catheter ablation was associated with a lower risk of dementia compared to antiarrhythmic drugs, and remained significant for males and females, but no further subgroup analyses were performed. 15 A previous study in 11,726 patients with AF in Korea also examined subgroups, and the association between catheter ablation and lower risk of dementia persisted when participants were grouped according to the following characteristics: sex, residential area, health care utilization, heart failure or stroke history, estimated stroke risk, and OAC use during follow-up. 10 However, the association was not statistically significant for individuals aged ≥75 years, and individuals without hypertension and with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a study of patients with at least 3 years follow‐up suggested >4000 patients with AF who received catheter ablation had a comparable risk of dementia to >16,000 patients without AF 14 . A US‐based study of 38,176 patients with AF after propensity‐score matching suggested catheter ablation was associated with a lower risk of dementia compared to antiarrhythmic drugs, and remained significant for males and females, but no further subgroup analyses were performed 15 …”

Section: Discussionmentioning

confidence: 99%

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Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

Harrison,

Buckley,

Austin

et al. 2023

J American Geriatrics Society

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BackgroundAtrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co‐morbidity status, and oral anticoagulant use.MethodsThe research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity‐score matched cohorts.ResultsAfter propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co‐morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45–0.61). The catheter ablation cohort also had a lower risk of all‐cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55–0.61). These associations remained in subgroup analyses in individuals aged 65–79 years, ≥80 years, males, females, participants who received OACs during follow‐up, participants with paroxysmal and non‐paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.ConclusionThe observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient‐centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

Harrison,

Buckley,

Austin

et al. 2023

J American Geriatrics Society

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“…More recently, it has been supposed that AF catheter ablation might be more effective than pharmacologic rhythm control alone at cutting the risk for dementia. A meta-analysis of five prospective observational studies, comprising more than 60 000 patients, having a median follow-up of 12.5 years indicates a nearly 30% increased risk of dementia, independently from cerebrovascular accidents/TIAs in AF; 42 similarly, an observational ongoing study 43 comprising 20 years of data is probably approaching a 41% reduction ( P < 0.0001) in risk for dementia among those who underwent catheter ablation after attempted rhythm control with AAD, compared with those managed with pharmacologic rhythm control therapy alone.…”

Section: Cognitive Decline/vascular Dementia As Atrial Fibrillation-r...mentioning

confidence: 99%

The gray areas of oral anticoagulation for prevention of thromboembolic events in atrial fibrillation patients

Curcio

Anselmino

Biase

et al. 2023

Journal of Cardiovascular Medicine

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Thromboembolic events (TEE) associated with atrial fibrillation (AF) are highly recurrent and usually severe, causing permanent disability or, even, death. Previous data consistently showed significantly lower TEE in anticoagulated patients. While warfarin, a vitamin K antagonist, is still used worldwide, direct-acting oral anticoagulants (DOACs) have shown noninferiority to warfarin in the prevention of TEE, and represent, to date, the preferred treatment. DOACs present favorable pharmacokinetic, safety and efficacy profiles, especially among vulnerable patients including the elderly, those with renal dysfunction or previous TEE. Yet, regarding specific settings of AF patients it is unclear whether oral anticoagulation therapy is beneficial, or otherwise it is the maintenance of sinus rhythm, mostly achieved through a catheter ablation-based rhythm control strategy, that prevents the causal complications linked to AF. While it is known that low-risk patients [CHA2DS2-VASc 0 (males), or score of 1 (females)] present low ischemic stroke or mortality rates (<1%/year), it remains unclear whether they need any prophylaxis. Furthermore, the appropriate anticoagulation regimen for those individuals requiring cardioversion, either pharmacologic or electric, as well as peri-procedural anticoagulation in patients undergoing trans-catheter ablation that nowadays encompasses different energies, are still a matter of debate. In addition, AF concomitant with other clinical conditions is discussed and, lastly, the choice of prescribing anticoagulation to asymptomatic patients diagnosed with subclinical AF at either wearable or implanted devices. The aim of this review will be to provide an update on current strategies in the above-mentioned settings, and to suggest possible therapeutic options, finally focusing on AF-related cognitive decline.

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“…AF has been widely associated with increased risk of dementia and better control of AF may reduce this risk. Zeitler et al using the Optum Clinformatics database, evaluated the propensity-matched risk of dementia in 19,088 patients following catheter ablation versus 19,088 patents treated with antiarrhythmic drugs (AAD) for AF [68]. Catheter ablation was associated with a 41% reduction in risk of dementia (HR 0.59; 95% CI 0.51-0.68; P\0.0001) and a 49% reduction in the secondary endpoint of mortality (HR 0.51, 95% CI 0.46-0.55, P\0.001), supporting the value of effective AF treatment in this population.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

et al. 2023

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Introduction: Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context. Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results: A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated. Conclusion: This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.

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Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs

Cited by 13 publications

References 27 publications

Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

The gray areas of oral anticoagulation for prevention of thromboembolic events in atrial fibrillation patients

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

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