Key result
Catheter ablation linked to ~48% lower dementia risk vs. medical therapy in AF.
Why the study?
Observational evidence suggests catheter ablation may be associated with a lower risk of dementia in AF patients, but further research is needed.
Does catheter ablation reduce the risk of incident dementia and mortality in older adults with atrial fibrillation?
Cohort (n=41,492)
Yes
Does catheter ablation reduce the risk of incident dementia and mortality in older adults with atrial fibrillation?
In older adults with atrial fibrillation, catheter ablation is associated with a markedly lower risk of incident dementia and all-cause mortality compared to rate or rhythm control medications alone.
Research clause: Extends prior observational signals, leaves open whether ablation causally prevents.
BACKGROUND: Atrial 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. METHODS: The 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. RESULTS: After 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. CONCLUSION: The 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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Harrison et al. (2023) conducted a cohort in Atrial fibrillation (n=41,492). Catheter ablation vs. Antiarrhythmic or rate control medicines alone was evaluated on Incident dementia within 5 years (HR 0.52, 95% CI 0.45-0.61). Catheter ablation was associated with a significantly lower risk of incident dementia (HR 0.52) compared to medical therapy alone in older adults with atrial fibrillation.
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