Domain-specific cognitive changes after catheter ablation in atrial fibrillation: evidence from the REMEDES for alzheimer (R4ALZ) tool

Background/Introduction Atrial fibrillation (AF) is associated with cognitive impairment, but the cognitive impact of catheter ablation (CA) and the sensitivity of domain-specific tools compared to global screening remain uncertain. Purpose This study evaluated post-ablation cognitive changes using both the Montreal Cognitive Assessment (MoCA) and the novel domain-specific REMEDES for Alzheimer (R4Alz) tool. Methods In this prospective observational study, 75 patients undergoing CA for AF (54 cryoballoon, 21 pulsed field ablation [PFA]) and a non-ablation AF control cohort (n=40) underwent cognitive testing with MoCA and selected R4Alz subdomains at baseline and six months post-ablation. Brain MRI was performed before and within 48 hours after ablation to detect new infarcts. Results Baseline MoCA and R4Alz scores were comparable between ablation and control cohorts (27.16 ± 2.03 vs 26.85 ± 2.05; p = 0.39 and 175.08 ± 11.3 vs 174.51 ± 11.16; p = 0.81, respectively). No new infarcts were detected post-ablation. At six months, MoCA changes were non-significant (Δ = 0.27 ± 1.55; p = 0.141). In contrast, R4Alz total scores improved significantly after ablation (Δ = 2.81 ± 5.61; p < 0.001), driven by gains in short-term working memory (Δ = 1.31 ± 2.47; p < 0.001) and perceptual inhibition (Δ = 0.37 ± 1.62; p = 0.049). Higher CHA2DS2-VASc scores predicted greater R4Alz improvement. Conclusions CA was associated with improvement in domain-specific cognitive functions without MRI-detected injury, indicating potential cognitive benefit of rhythm restoration and supporting the use of sensitive tools such as R4Alz in AF follow-up.