Catheter Ablation for AFib Could Help Stave Off Cognitive Decline in Older Patients

Bahadar Srichawla, DO
Credit: UMass Chan Medical School

Undergoing catheter ablation for atrial fibrillation could reduce the long-term risk of cognitive decline in older patients, according to the results of a new study.

Presented at the American Academy of Neurology (AAN)’s 75th annual meeting, results of the study, which included more than 850 participants, suggest undergoing catheter ablation was associated with a 36% decrease in likelihood of developing cognitive impairment during the 2-year study period relative to medical management alone.¹

“Previous studies have found that people with arrythmias may have long-term thinking and memory problems due to how this condition may affect the blood flow to the brain,” said Bahadar Srichawla, DO, of University of Massachusetts Chan Medical School in Worcester and a member of the American Academy of Neurology.² “Our findings show that treatment with catheter ablation is linked to a reduced risk of cognitive impairment.”

The most common form of arrhythmia, atrial fibrillation is responsible for more than 450,000 hospitalizations and 158,000 deaths in the US annually.³ A meta-analysis published in 2022 suggested catheter-based ablation reduced risk of stroke, all-cause mortality, and hospitalization for heart failure by 39%, 40%, and 43%, respectively.⁴

Citing previously published data purporting a potential long-term cognitive benefit, based on ablation’s effects on correcting the cerebrovascular hemodynamic profile, Srichawla and a team of colleagues sought to cross-sectionally and longitudinally examine associations between catheter ablation and cognitive function in older patients with atrial fibrillation. Named the Systematic Assessment of Geriatric Elements (SAGE-AF) study, the trial enrolled patients aged 65 years of age or older from internal medicine and cardiology clinics in Massachusetts and Georgia between 2016 and 2018.¹

For the purpose of analysis, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool, which was evaluated at baseline and again at 1- and 2-years post-procedure. Investigators used multivariate-adjusted logistic regression to estimate associations of risk for cognitive decline and hemorrhagic events with catheter ablation compared with standard medical management. Investigators noted cognitive impairment was defined as a MoCA score of 23 or less.¹

A total of 887 participants were included in the study. This cohort had a mean age of 75.2 (SD, 6.7) years, 48.6% were women, and 87.4% identified as non-Hispanic White. Overall, 21.8% of participants had received a catheter ablation prior to enrollment. Compared to those with no history of catheter ablation, those who had undergone ablation were more likely to have had an implantable cardiac device (45.6% vs 27.5%; P <.001) and persistent atrial fibrillation (31.1% vs 22.5%; P <.05).¹

Upon analysis, results indicated the mean MoCA score for those who had a history of ablation was 25 compared to a mean score of 23 among those without a history of catheter ablation. In adjusted analyses, results suggested those with a history of ablation and a 36% reduction in likelihood of developing cognitive impairment during the 2-year study period relative to their counterparts who received only medical management. Further analysis indicated there were no significant differences in hemorrhagic/ischemic events observed in either arm of the study and a subgroup analysis of patients treated with warfarin against other anticoagulants did not indicate a significant effect on cognitive decline.¹

“Our results are encouraging, however there are many factors taken into consideration when catheter ablation is prescribed,” Srichawla added.² “More research is needed to confirm our results.”

References:

1. Srichawla B, Hamel A, Cook P, et al. The Effect of Catheter Ablation on Cognitive Outcomes in Elderly Patients with Atrial Fibrillation: SAGE-AF. Presented at: American Academy of Neurology (AAN)’s 75th annual meeting; April 18, 2023. Boston, MA. April 18, 2023
2. Could fixing a problem with the heart be good for your brain? EurekAlert. https://www.eurekalert.org/news-releases/986178. Published April 18, 2023. Accessed April 18, 2023.
3. Atrial fibrillation. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Published October 14, 2022. Accessed April 18, 2023.
4. Shaik TA, Haseeb M, Faisal S, et al. Impact of Catheter Ablation on Long-Term Outcomes in Patients With Atrial Fibrillation: A Meta-Analysis. Cureus. 2022;14(9):e29202. Published 2022 Sep 15. doi:10.7759/cureus.29202