Key result
Rhythm-control therapy was significantly associated with a lower risk of future dementia compared with rate-control in patients with atrial fibrillation (HR 0.74; 95% CI 0.62-0.89).
Why the study?
Atrial fibrillation is an independent risk factor for cognitive impairment and dementia, but whether rhythm-control therapy can protect cognitive function remains unclear.
Do rhythm-control strategies reduce the risk of dementia and cognitive impairment in patients with atrial fibrillation compared to rate-control?
Meta-Analysis (n=193,830)
Do rhythm-control strategies reduce the risk of dementia and cognitive impairment in patients with atrial fibrillation compared to rate-control?
Hazard Ratio: 0.74 (95% CI 0.62–0.89)
Rhythm-control strategies, particularly AF ablation, are associated with a significantly lower risk of dementia and improved cognitive function compared to rate-control in patients with atrial fibrillation.
Supports rhythm-control preference in AF to potentially lower dementia risk; confirms observational link but leaves open causality in RCTs.
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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Guo et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=193,830). Rhythm-control therapy vs. Rate-control therapy was evaluated on Future dementia (HR 0.74, 95% CI 0.62-0.89). Rhythm-control therapy was significantly associated with a lower risk of future dementia compared with rate-control in patients with atrial fibrillation (HR 0.74; 95% CI 0.62-0.89).
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