Catheter ablation could reduce dementia risk in AF vs. medical therapy
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Patients with atrial fibrillation who underwent catheter ablation may have a lower risk for dementia compared with those treated with medical therapy, researchers found in a retrospective analysis.
“We found that successful ablation significantly reduced dementia by 44% compared with medical therapy, but if ablation failed, we did not see a significant reduction in risk,” Boyoung Joung, MD, professor of cardiology and internal medicine at Yonsei University College of Medicine in Seoul, South Korea, told Healio. “This suggests that it is maintaining the regular rhythm of the heart with successful ablation, and not ablation itself, that may contribute to a lower risk of dementia in patients with atrial fibrillation and provides evidence to assist clinicians in pursuing sinus rhythm in AF patients.”
Korean patients with AF
In this study published in the European Heart Journal, Daehoon Kim, MD, cardiology fellow at Yonsei University College of Medicine, and colleagues analyzed data from patients with AF from the National Health Insurance Service of Korea from 2005 to 2015. Patients were treated with catheter ablation (n = 9,119; median age, 57 years; 77% men) or medical therapy (n = 17,978; median age, 67 years; 68% men). Researchers also performed propensity score matching to correct for differences between the ablation group (n = 5,863; median age, 60 years; 74% men) and the medical therapy group (n = 5,863; median age, 60 years; 75% men).
The primary outcome for this study was the initial occurrence of overall dementia. Secondary outcomes were defined as the development of dementia subtypes, including vascular dementia and Alzheimer’s disease.
In the propensity score-matched groups, fewer patients in the ablation group developed dementia compared with the ablation group (164 patients vs. 308 patients) during a median follow-up of 52 months. This equated to incidence rates of 5.6 per 1,000 person-years in the ablation group and 8.1 per 1,000 person-years in the medical therapy group (absolute rate difference, 2.5; 95% CI, 3.8 to 1.2). The risk for developing dementia decreased by 27% in patients who underwent ablation compared with those treated with medical therapy after adjusting for clinical variables and competing risk for mortality (HR = 0.73; 95% CI, 0.58-0.93).
The link between catheter ablation and the risk for dementia remained consistent after additional censoring for incident stroke (HR = 0.76; 95% CI, 0.61-0.95). The association between catheter ablation and a reduced risk for dementia was more prominent in successful procedures compared with the overall group, although this was not observed in ablation failures.
Compared with medical therapy, catheter ablation was linked to a lower incidence and risk for vascular dementia (1.2 per 1,000 person-years vs. 2.2 per 1,000 person-years; HR = 0.5; 95% CI, 0.33-0.74) and Alzheimer’s disease (4.1 per 1,000 person-years vs. 5 per 1,000 person-years; HR = 0.77; 95% CI, 0.61-0.97).
Additional research
“A randomized clinical trial is needed to confirm the observed association between catheter ablation and lower dementia risk as a cause-effect relationship,” Joung said in an interview.
For more information:
Boyoung Joung, MD, can be reached at cby6908@yuhs.ac.
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