Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers

Figures

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  Figure 1. Computer and Head-Mounted Display Compatible With ViewMind Atlas Cognition App

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  Figure 2. Go/No-Go Visual task Two examples are shown below. The circle highlighted in green on the screen indicates the direction of the gaze.

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  Figure 3. N-Back Visual task During the task, red circles appear sequentially within the peripheral rectangles, while the patient fixates his or her gaze on the central cross. After the sequence, the patient must quickly look at the rectangles in the reverse order to the appearance of the circles.

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  Figure 4. The Study Flow Chart

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  Figure 5. The Number of Complete Sequences During the N-Back Task A box-plot graph to demonstrate the performance of the general anesthesia and moderate sedation groups on the and N-back cognitive task as measured by the number of complete sequences.

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  Figure 6. Gazing Recognition Speed (ms) During the N-Back Task A box-plot graph to demonstrate the performance of the general anesthesia and moderate sedation groups on the and N-back cognitive task as measured by gazing recognition speed (ms).

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  Figure 7. The Number of Start Fixations Off-Center During the N-Back Task A boxplot to demonstrate the performance of the general anesthesia and moderate sedation groups on the and N-back cognitive task as measured by the number of start fixations off-center (number).

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  Figure 8. The Number of Wrong Fixations on Hitbox During the N-Back Task A box-plot graph to demonstrate the performance of the general anesthesia and moderate sedation groups on the and N-back cognitive task as measured by the number of wrong fixations on hitbox (number).

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  Figure 9. The % of Correct Fixations (%) During the Go/No Go Task A box-plot graph panel to demonstrate the performance of the general anesthesia and moderate sedation groups on the Go/No Go task as measured by the % of correct fixations (%).

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  Figure 10. Exam Duration (Minutes) During the Go/No Go Task A box-plot graph panel to demonstrate the performance of the general anesthesia and moderate sedation groups on the Go/No Go task as measured by exam duration (minutes).

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  Central Illustration. Prospective Evaluation of Sedation During Left Atrial Appendage Occlusion on Cognition Using Oculometrics Prospective evaluation of the impact of sedation during left atrial appendage occlusion on cognitive function using oculomotor biomarkers. We assessed cognitive performance following left atrial appendage occlusion performed under general anesthesia vs moderate sedation, using several digital oculomotor biomarkers. Forty patients (n = 20 general anesthesia, n = 20 moderate sedation) were prospectively enrolled and tested at baseline (V1), 6 hours postprocedure (V2), and 45 days (V3) using Go/No Go and N-Back tasks. Patients in the moderate sedation group showed significant long-term (V1 vs V3) improvement in working memory (Δ n complete sequences, P = 0.005) and processing speed (Δ n wrong fixations V1 vs V3, P = 0.050), as measured by the N-Back task while there were no differences in the general anesthesia group (P = 0.180 for Δ n complete sequences, P = 0.410 for Δ n wrong fixations on hitbox, and P = 0.310). This proof-of-concept study demonstrates the utility of oculomotor-based biomarkers in assessing cognition periprocedurally. LAAO = left atrial appendage occlusion.