Key result
Early AF ablation linked to ~57% lower 3-year dementia risk vs. late ablation.
Why the study?
Early catheter ablation for AF is associated with improved thromboembolic outcomes compared with late ablation, but whether earlier intervention protects against dementia remained unclear.
Does early catheter ablation within 1 year of diagnosis reduce the 3-year risk of incident dementia compared to delayed ablation in patients with paroxysmal atrial fibrillation?
Cohort (n=43,643)
Yes
Does early catheter ablation within 1 year of diagnosis reduce the 3-year risk of incident dementia compared to delayed ablation in patients with paroxysmal atrial fibrillation?
Early catheter ablation within 1 year of paroxysmal AF diagnosis is associated with a significantly lower 3-year risk of incident dementia and Alzheimer's disease compared with ablation delayed by 3 to 5 years.
Hypothesis-generating for early ablation timing in paroxysmal AF; leaves open confirmation in randomized trials before practice change.
Background Early catheter ablation for atrial fibrillation (AF) has been associated with improved thromboembolic outcomes compared with late ablation; however, whether earlier intervention results in a protective effect against dementia remains unclear. Objective To compare dementia risk among patients with AF undergoing early versus delayed ablation following initial diagnosis. Methods Two cohorts were evaluated using the TriNetX platform: (i) patients with a first diagnosis of paroxysmal AF who underwent ablation within 1 year of diagnosis (early ablation group) versus those who underwent ablation between 1 and 3 years after diagnosis (intermediate ablation group); and (ii) early ablation group versus ablation between 3 and 5 years after diagnosis (late ablation group). The primary objective was the 3-year risk of incident dementia. Secondary objectives were the risk of Alzheimer’s disease, vascular dementia, and dementia without behavioural disturbance. Results Before propensity score matching (PSM), patients in early ablation group (n=21,009, 33.6% female), compared to intermediate ablation group (n=12,753, 35.1% female) and late ablation group (n=9,881, 35.5% female) were younger, with fewer comorbidities such as hypertension and stroke. After PSM, patients in early ablation group compared with intermediate ablation group (n=12,146), showed a non-significant lower risk of dementia (HR: 0.74, 95% CI: 0.49-1.12) and Alzheimer’s disease (HR: 0.83, 95% CI 0.45-1.53). After PSM, patients in early ablation group compared to late ablation group (n=9,152), showed significantly lower risk of dementia (HR: 0.43, 95% CI: 0.28-0.65) and Alzheimer’s disease (HR: 0.45, 95% CI: 0.24-0.86). Conclusion Early ablation within 1 year of AF diagnosis, compared with delayed ablation, was associated with a reduced risk of 3-year dementia and Alzheimer’s disease, highlighting the potential cognitive benefits of early rhythm control strategies.
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Askarinejad et al. (2026) conducted a cohort in Paroxysmal atrial fibrillation (n=43,643). Early catheter ablation (within 1 year of AF diagnosis) vs. Delayed catheter ablation (intermediate: 1-3 years; late: 3-5 years after diagnosis) was evaluated on 3-year risk of incident dementia (HR 0.43, 95% CI 0.28-0.65). Early catheter ablation within 1 year of AF diagnosis significantly reduced 3-year dementia risk compared with late ablation at 3-5 years (HR 0.43, 95% CI 0.28-0.65).
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