Does catheter ablation improves cognitive performance in atrial fibrillation? A quantitative meta-analysis

Background While atrial fibrillation (AF) is linked to cognitive decline and dementia, it remains unclear whether rhythm restoration itself enhances cognitive performance independently of long-term dementia prevention. Catheter ablation (CA) achieves a more durable sinus rhythm than medical therapy, yet evidence for its short- and medium-term effects on neurocognitive function is heterogeneous. Purpose To evaluate whether CA improves objective cognitive test performance compared with anti-arrhythmic drug therapy in adults with AF, focusing on change in standardized cognitive scores rather than dementia incidence. Methods We conducted a random-effects meta-analysis of prospective studies enrolling adults (≥18 years) with AF and no baseline dementia who underwent CA or medical rhythm control. Cognitive outcomes included mean change from baseline on validated scales, the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Telephone Interview for Cognitive Status–modified (TICS-m). Effect sizes were expressed as standardized mean differences (Hedges g) using restricted maximum-likelihood estimation. A Bayesian hierarchical model with weakly informative priors was applied for sensitivity analysis. Results Four studies (n = 1,247; 453 CA, 794 medical) with their longest follow-up [104 weeks] were included. The pooled standardized mean difference was 0.70 [95 % CI 0.11–1.30]; p = 0.021, indicating a moderate cognitive improvement following CA. Heterogeneity was substantial (I² = 92 %), driven mainly by variation in test instruments and FU duration. Bayesian modeling yielded a similar posterior mean effect of 0.63 [95 % CrI –0.13 to 1.31]. No study reported cognitive decline after ablation. Effects were consistent across ablation modalities (radiofrequency and cryoballoon). Conclusion Among adults with AF, catheter ablation was associated with measurable improvements in standardized cognitive test performance compared with pharmacologic rhythm control. These findings suggest that restoration of sustained sinus rhythm may confer near-term neurocognitive benefits distinct from the longer-term reduction in dementia risk. Future randomized studies should use harmonized cognitive endpoints to validate these functional gains and clarify underlying mechanisms.