Catheter ablation for atrial fibrillation did not significantly affect neurocognitive function at 6 months compared to drug therapy, but was associated with greater changes in cerebral blood flow.
Cohort (n=145)
Does catheter ablation of atrial fibrillation improve neurocognitive function, cerebral blood flow, and hippocampal volume compared to drug therapy in patients with atrial fibrillation?
Catheter ablation of atrial fibrillation does not significantly change neurocognitive function at 6 months compared to drug therapy, but is associated with improvements in cerebral blood flow and hippocampal volume.
BACKGROUND The effect of atrial fibrillation (AF) catheter ablation on neurocognitive function is debated. OBJECTIVES This study sought to investigate changes in cognitive function and brain imaging after AF ablation. METHODS Patients undergoing AF catheter ablation were screened. Participants underwent assessments of neurocognitive function using the Cambridge Neuropsychological Test Automated Battery before and 3 and 6 months after ablation. Patients with AF managed by drug therapy served as a control group. A subset of patients underwent brain magnetic resonance imaging before and 6 months after the procedure, where cerebral blood flow (CBF) and bilateral hippocampal volume (HV) were assessed. RESULTS One hundred forty-five patients, 94 in the ablation group and 51 in the control group (aged 64 ± 11 years, 70% men, 41% with paroxysmal AF), were studied. Changes in neurocognitive function tests scores were not significantly different between groups. Arrhythmia recurrence and AF type (paroxysmal or persistent) did not significantly affect the outcome. In the magnetic resonance imaging subgroup (51 patients: ablation 42 and control 9), change in CBF (ΔCBF) and proportional change in HV were significantly different between groups (+46 mL/min IQR: -17 to +111 vs -45 mL/min IQR: -70 to +9, P = 0.007; +0.1% IQR: -1.1 to +0.8 vs -1.0% IQR: -2.0 to +0.1, P = 0.043; for ablation vs control, respectively). Those with ΔCBF more than +35 mL/min had greater improvements in memory and new learning score than those with ΔCBF less than +35 mL/min (+2 IQR: -0.5 to +5 vs 0 IQR: -3 to +3, P = 0.048). CONCLUSIONS In this study, AF ablation did not significantly affect neurocognitive function at the 6-month follow-up. Compared with drug therapy, ablation was associated with greater changes in CBF and HV, and patients with CBF improvement, regardless of treatment assignment, showed improved performance in memory and new learning.
Yamamoto et al. (Sun,) conducted a cohort in Atrial fibrillation (n=145). Catheter ablation vs. Drug therapy was evaluated on Changes in neurocognitive function tests scores. Catheter ablation for atrial fibrillation did not significantly affect neurocognitive function at 6 months compared to drug therapy, but was associated with greater changes in cerebral blood flow.