Catheter ablation improved cognitive outcomes in older adults with atrial fibrillation

Key takeaways:

• SAGE-AF study included 887 older adults with atrial fibrillation.
• Patients who underwent catheter ablation were significantly less likely to develop cognitive impairment vs. those given only medical management.

BOSTON — Older adults with atrial fibrillation who underwent catheter ablation developed less cognitive impairment than those receiving only medical management, according to a presenter at the American Academy of Neurology annual meeting.

“Atrial fibrillation is the most common cardiac arrythmia in the United States,” Bahadar S. Srichawla, DO, MS, co-investigator and resident physician in the department of neurology at University of Massachusetts Chan Medical School, told attendees. “It affects approximately 3 million to 6 million people.”

Srichawla and colleagues examined associations between catheter ablation and cognitive function in older adults with AF compared with medical management alone, as previous research shown that AF is independently linked with cognitive decline.

They conducted the observational cohort Systematic Assessment of Geriatric Elements (SAGE)-AF study and enrolled 887 ambulatory individuals aged 65 years and older (mean age, 75.2 years; 87.4% white non-Hispanic; 48.6% women) between 2016 and 2018 who were eligible to receive oral anticoagulants. Researchers assessed cognitive function with the Montreal Cognitive Assessment (MoCA) tool at baseline and again at 1-and-2-year intervals, defining impairment as a MoCA score of 23 or higher.

According to results, 193 individuals underwent cardiac ablation prior to study enrollment and more frequently had an implantable cardiac device (45.6% vs. 27.5%) and were more likely to have persistent AF (31.1% vs. 22.5%). Further, patients who underwent cardiac ablation were significantly less likely to demonstrate cognitive impairment during the 2-year study period than those who received standard medical management alone (adjusted OR = 0.7; 95% CI, 0.5-0.97), even after propensity score adjustments.

Researchers also reported that cognitive function at 2 years was similar in patients who received warfarin compared with other anticoagulants.

“Additional future direction should look at certain parameters related to cerebral hemodynamics, including [near-infrared spectroscopy] or diffuse correlation spectroscopy, to further validate these findings,” Srichawla said.