Catheter ablation of atrial fibrillation reduces the risk of dementia and hospitalization during a very long-term follow-up
Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, with rising incidences in the aging population [1]. AF is associated with higher risks of dementia characterized by progressive cognitive impairments with normal consciousness, regardless of the history of stroke or other shared risk factors [2]. Dementia has a 5% prevalence rate in the old population (>65 years), and the prevalence would double for every 5 years after the age of 65 [3]. The mechanisms of cognitive dysfunction and dementia associated with AF include cerebral thromboembolism, cerebral hypo-perfusion, and cerebral micro-bleeds [4]. Therefore, controlling cardiac rhythm is used to reduce the risks of dementia in AF patients [2].
In major clinical trials, pharmacological treatments aiming at rhythm control showed no beneficial effects in terms of morbidity, mortality, and dementia [5,6]. One major limitation of pharmacological approach to control rhythm in AF patients is the ineffectiveness and adverse effects associated with anti-arrhythmic drugs (AADs) [7]. To improve symptoms, exercise capacity, and quality of life, catheter ablation (CA) is a therapy in AF patients at different ages with multiple co-morbidities, while minimizing the ADD toxicities [8,9]. Although CA treatment might reduce the risk of cerebral thromboembolism and hypo-perfusion, silent cerebral infarctions (SCIs) during the CA procedure might adversely increase dementia risk [10]. Whether CA reduces the long-term dementia risks remains unclear.
In a prospective registry-based study, Bunch et al., reported that the risks of dementia and stroke are lower in AF patients undergoing CA (4212 compared with 16,848 age- and gender- matched AF patients without CA) [11]. Interestingly, AF patients receiving CA have similar long-term rates of dementia and stroke compared with patients without AF [11]. In that study, the follow-up duration is 3.1 years. But dementia is a progressive disease involving long-term cerebral degeneration, and the study of dementia is better based on longer follow-up [12]. We hypothesized that the risk of dementia is lower AF patients after CA when studied in long-term follow-up.
Section snippets
Methods
This study was approved in accordance with the Good Clinical Practice Guidelines by the Institutional Review Board (IRB Number: 201305044W and 2017-09-013BCF) of the Taipei Veterans General Hospital (TVGH). A detailed method section is included in an online supplement.
Baseline characteristics
Table 1 shows the baseline characteristics of the three groups. The three groups have similar percentage of male patients (p = 0.99) and age (p = 0.17). The prevalence of hypertension (p = 0.98), CKD (p = 0.83), and COPD (p = 0.057) were not different among the three groups. AF with CA group patients have higher prevalence of coronary artery disease (p < 0.001) and stroke/transient ischemic attack (TIA) (p < 0.001) than that in AF without CA group. Control group patients have higher prevalence
Discussion
Three major findings emerged from this study: (1) CA in AF patients reduced the risk of dementia and AF-related hospitalization compared with those without CA; (2) The risk of dementia was similar between AF patients receiving CA and those without history of AF; and (3) CA in AF patients has a lower risk of dementia than AF patients without CA, particularly clear in older patients aged >65 years.
Conclusions
CA in AF patients reduced the risk of dementia and AF-related hospitalization compared with those without CA under very long-term follow-up, and the effects on dementia were particularly clear for older patients (aged >65 years). We conclude that CA is an effective therapeutic strategy to reduce dementia and hospitalization risk in AF patients.
Sources of funding
This work was supported by Ministry of Science and Technology of Taiwan (MOST 107-2314-B-010-061-MY2, MOST 106-2314-B-010-046-MY3); Grant of Taipei Veterans General Hospital (V108C-032, C17-095); Research Foundation of Cardiovascular Medicine (107-02-036), and Szu-Yuan Research Foundation of Internal Medicine (No. 108016).
Declaration of competing interest
None for all authors.
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2022, American Heart JournalCitation Excerpt :First, there was 41% reduction in the risk of a dementia diagnosis in patients with AF treated with CA compared with AAD. This finding is consistent with prior work demonstrating a reduction in dementia associated with maintenance of sinus rhythm in general22 as well as those evaluations of CA specifically in which CA has consistently demonstrated improved suppression of AF over a strategy of AAD alone regardless of sex.17-19,23-25 In an analysis of Korean National Data, Kim et al observed a reduction in the risk of dementia of 27% (HR 0.73, 95% CI 0.58-0.93) in a propensity matched population of nearly 200,000 all-comers with AF treated with CA versus AAD.
Impact of catheter ablation of atrial fibrillation on reduction of the risks of dementia and hospitalization
2020, International Journal of Cardiology