Key result
AF catheter ablation is linked to a ~3-point greater cognitive score gain vs. medical therapy.
Why the study?
Atrial fibrillation is associated with cognitive impairment, but the cognitive effects of catheter ablation using contemporary techniques remain uncertain.
Does catheter ablation for atrial fibrillation improve global and domain-specific cognitive outcomes at 6 months compared to standard medical therapy?
Cohort (n=115)
No
Does catheter ablation for atrial fibrillation improve global and domain-specific cognitive outcomes at 6 months compared to standard medical therapy?
Mean Difference: 3.18 (95% CI 0.87–5.49)
p-value: p=.007
Catheter ablation for atrial fibrillation is not associated with short-term cognitive decline and may yield subtle, domain-specific cognitive improvements compared to medical therapy.
Ablation was associated with modest cognitive gains versus medical therapy at 6 months; leaves open causality and requires randomized trials before practice change.
Importance: Atrial fibrillation (AF) is associated with cognitive impairment, but the cognitive effects of catheter ablation (CA) using contemporary techniques remain uncertain. Objective: To evaluate changes in global and domain-specific cognitive function after CA for AF. Design, Setting, and Participants: This prospective cohort study included consecutive patients undergoing CA for AF and a nonablation AF control group at a tertiary university hospital in Greece between January 2022 and June 2024. Cognitive assessments were performed at baseline and at 6-month follow-up. Exposures: CA using cryoballoon or pulsed field ablation (PFA). Main Outcomes and Measures: Changes from baseline to 6 months in Montreal Cognitive Assessment (MoCA) scores and the novel REMEDES for Alzheimer (R4Alz) total and subdomain scores. Brain magnetic resonance imaging was performed before and within 48 hours after ablation to detect new cerebral infarcts. Results: Among 75 patients (40 [53.3%] female) undergoing ablation (mean [SD] age, 61.9 [10.4] years; 54 cryoballoon, 21 PFA) and 40 in a nonablation control group (26 [65.0%] female; mean [SD] age,61.4 [9.2] years), baseline cognitive scores were similar between groups. No new cerebral infarcts were detected after ablation. At 6 months, MoCA scores in the ablation group did not change significantly (mean change, 0.27; 95% CI, -0.08 to 0.62), whereas R4Alz total scores increased (mean change, 2.81; 95% CI, 1.55 to 4.07), mainly associated with gains in short-term working memory and perceptual inhibition. No significant changes were observed in the control group. Compared with the control group, the ablation cohort demonstrated significantly greater improvements in both MoCA (mean difference in change, 0.74; 95% CI, 0.17 to 1.31; P = .01) and R4Alz total score (mean difference in change score, 3.18; 95% CI, 0.87 to 5.49; P = .007). In adjusted analyses accounting for baseline cognitive score and clinical covariates, ablation was independently associated with higher follow-up MoCA (β = 0.88; 95% CI, 0.31 to 1.44) and R4Alz scores (β = 3.80; 95% CI, 1.70 to 5.90). Conclusions and Relevance: In this prospective observational cohort study of 75 patients undergoing CA for AF, ablation was not associated with cognitive decline and was instead associated with modest short-term improvements in selected cognitive domains. Domain-specific assessment detected changes not captured by global cognitive screening, suggesting that modern ablation techniques may be associated with early subtle cognitive gains.
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Chiotis et al. (2026) conducted a cohort in Atrial fibrillation (n=115). Catheter ablation vs. Nonablation medical therapy was evaluated on Change in REMEDES for Alzheimer (R4Alz) total score from baseline to 6 months (MD 3.18, 95% CI 0.87 to 5.49, p=.007). Catheter ablation for atrial fibrillation was associated with significantly greater improvements in R4Alz total cognitive scores (mean difference 3.18) compared to medical therapy at 6 months.