Medical therapy

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

This article was originally published here

J Interv Card Electrophysiol. 2022 April 5. doi: 10.1007/s10840-022-01196-y. Online ahead of print.


OBJECTIVE: Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether restoring sinus rhythm with catheter ablation can modify this risk. We performed a systematic review of studies comparing cognitive outcomes after catheter ablation with medical treatment (rate and/or rhythm control) in atrial fibrillation.

METHODS: The following databases were searched from inception to 17 October 2021: PubMed, OVID Medline, Embase, and Cochrane Library. Inclusion criteria included studies comparing catheter ablation with medical treatment (rate and/or rhythm control combined with anticoagulation, if applicable) that included cognitive assessment and/or diagnosis of dementia as a result.

RESULTS: A total of 599 records were reviewed. Ten studies involving 15,886 patients treated with catheter ablation and 42,684 patients treated with medical therapy were included. Studies comparing the impact of catheter ablation to medical therapy on quantitative assessments of cognitive function have yielded conflicting results. In studies examining new-onset dementia during follow-up, catheter ablation was associated with a lower risk of later diagnosis of dementia compared to medical treatment (risk ratio: 0.60 (95% confidence interval %: 0.42-0.88, p

CONCLUSION: Accumulating evidence linking atrial fibrillation and cognitive impairment warrants the design of atrial fibrillation treatment strategies aimed at minimizing cognitive decline. However, the impact of catheter ablation and medical treatment of atrial fibrillation on cognitive decline is currently uncertain. Future studies investigating treatment strategies for atrial fibrillation should include cognitive outcomes as important clinical endpoints.

PMID:35380337 | DOI:10.1007/s10840-022-01196-y