Association Between Baseline Cognitive Impairment and Atrial Fibrillation Recurrence After Catheter Ablation

BACKGROUND: Cognitive impairment is common among patients with atrial fibrillation (AF), yet its prognostic significance in the context of catheter ablation remains unclear. AIMS: We aimed to investigate whether baseline cognitive impairment, assessed by the Montreal Cognitive Assessment (MoCA), was associated with post-ablation AF recurrence. METHODS: Based on the China-AF Registry, we identified 2692 patients with nonvalvular AF who underwent index catheter ablation and had baseline MoCA assessments from 2022 to 2024. Patients were stratified into mild cognitive impairment (MCI, MoCA ≤ 26) and normal cognition (MoCA > 26) groups. The primary outcome was AF recurrence beyond the blanking period. The secondary outcome was a composite of all-cause death, ischemic stroke, and major bleeding. To adjust for confounding factors, we applied inverse probability of treatment weighting (IPTW) methodology. Weighted Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS: After IPTW adjustment, all baseline covariates were well balanced (all standardized mean differences < 0.03). Over a median follow-up of 218 days (IQR, 192-376), the MCI group had a significantly higher risk of AF recurrence (aHR 1.48; 95% CI, 1.27-1.73; p < 0.001). The composite secondary endpoint did not demonstrate a statistically significant between-group difference (aHR, 1.05; 95% CI, 0.25-4.52; p = 0.945). The association between baseline MCI and AF recurrence was consistent across all prespecified subgroups (all p for interaction > 0.05). CONCLUSION: In this large prospective registry study, an independent association was observed between baseline cognitive impairment and an elevated risk of post-ablation AF recurrence. Cognitive assessment may be useful for risk stratification but requires external validation. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT06987825.