Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

BACKGROUND Atrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co-morbidity status, and oral anticoagulant use. METHODS The research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity-score matched cohorts. RESULTS After propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co-morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45-0.61). The catheter ablation cohort also had a lower risk of all-cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55-0.61). These associations remained in subgroup analyses in individuals aged 65-79 years, ≥80 years, males, females, participants who received OACs during follow-up, participants with paroxysmal and non-paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. CONCLUSION The observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient-centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required.

[1]  A. Russo,et al.  Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs. , 2022, American heart journal.

[2]  S. Harrison,et al.  Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis , 2022, Journal of The American Geriatrics Society.

[3]  Lin F. Yang,et al.  Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 , 2022, The Lancet. Public health.

[4]  J. Hippisley-Cox,et al.  Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases , 2021, BMJ.

[5]  G. Lip,et al.  Less dementia after catheter ablation for atrial fibrillation: a nationwide cohort study. , 2020, European heart journal.

[6]  T. Chao,et al.  Catheter ablation of atrial fibrillation reduces the risk of dementia and hospitalization during a very long-term follow-up. , 2019, International journal of cardiology.

[7]  G. Hindricks,et al.  Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial , 2019, JAMA.

[8]  M. Cesari,et al.  Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance , 2018, Journal of the American Geriatrics Society.

[9]  V. Gudnason,et al.  Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion , 2018, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[10]  M. Chung,et al.  2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation , 2017, Heart rhythm.

[11]  L. Friberg,et al.  Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: data from Swedish health registries. , 2016, European heart journal.

[12]  D. Singer,et al.  Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. , 2013, The American journal of cardiology.

[13]  Elizabeth A Stuart,et al.  Prognostic score-based balance measures can be a useful diagnostic for propensity score methods in comparative effectiveness research. , 2013, Journal of clinical epidemiology.

[14]  Junjian Zhang,et al.  Cerebral Hypoperfusion and Cognitive Impairment: The Pathogenic Role of Vascular Oxidative Stress , 2012, The International journal of neuroscience.

[15]  B. Horne,et al.  Patients Treated with Catheter Ablation for Atrial Fibrillation Have Long‐Term Rates of Death, Stroke, and Dementia Similar to Patients Without Atrial Fibrillation , 2011, Journal of cardiovascular electrophysiology.

[16]  Burr Hall,et al.  Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. , 2010, JAMA.

[17]  J. Cummings,et al.  Early-Onset Alzheimer’s Disease Is Associated With Greater Pathologic Burden , 2007, Journal of geriatric psychiatry and neurology.

[18]  OUP accepted manuscript , 2021, Age And Ageing.

[19]  G. Lip,et al.  Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. , 2019, European heart journal.