Cognitive deficits following catheter ablation for AF appear short-lived

A new study published in JACC: Clinical Electrophysiology suggests that postoperative cognitive dysfunction (POCD) was noticed after atrial fibrillation (AF) ablation. But this was just temporary; at the 12-month follow-up, the patient had fully recovered.

Following atrial fibrillation ablation, there have been reports of early postoperative cognitive impairment. POCD's long-term persistence, however, is uncertain. In order to ascertain if AF catheter ablation is linked to persistent cognitive impairment at 12-month follow-up, Ahmed Al-Kaisey and colleagues undertook this study.

In this prospective trial, 100 patients with symptomatic AF who had at least one antiarrhythmic treatment failure were randomized to receive either continued medical therapy or AF catheter ablation, and they were then monitored for a year after the procedure. Six cognitive tests that were given at baseline and again after 3, 6, and 12 months of follow-up were used to measure changes in cognitive performance.

The key findings of this study were:

1. 96 people finished the research regimen in total.

2. The average age was 59 years and 12 days (32% women and 46% had persistent AF).

3. At three months, the prevalence of new cognitive impairment in the ablation arm was 14% vs 2%, P = 0.03; at six months, 4% vs 2%, P = NS; and at twelve months, 0% vs 2%, P = NS.

4. Ablation time was a reliable predictor of POCD.

5. At 12 months, 14% of patients in the ablation group had significantly improved cognitive scores, compared to zero individuals in the medical arm (P = 0.007).

Researchers hypothesized that enhanced hemodynamic regulation, together with the discontinuation of AADs, might be major factors to early improvements in cognitive performance. Certainly, the usage of AADs was much lower among patients who showed cognitive improvement compared to individuals who did not show progress in cognitive tests.

Reference:

Al-Kaisey, A. M., Parameswaran, R., Bryant, C., Anderson, R. D., Hawson, J., Chieng, D., Voskoboinik, A., Sugumar, H., West, D., Azzopardi, S., Finch, S., Wong, G., Joseph, S. A., Kistler, P. M., & Kalman, J. M. (2023). Impact of Catheter Ablation on Cognitive Function in Atrial Fibrillation. In JACC: Clinical Electrophysiology. Elsevier BV. https://doi.org/10.1016/j.jacep.2023.02.020