Background
Atrial fibrillation ( AF) has been consistently associated with an increased risk of dementia . Observational evidence has suggested that catheter ablation may be associated with a lower risk of dementia in patients with AF, but more 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 between subgroups by age, sex, comorbidity status, and use of oral anticoagulants.
Methods
The research network primarily included healthcare organizations in the United States. This network was searched on September 28, 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years before 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% men) were included in each cohort with and without catheter ablation. The cohorts were well balanced in terms of age, sex, ethnicity, comorbidities, 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 analyzes in individuals aged 65–79 years, ≥80 years, men, women, participants receiving OAC 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
A large cohort study was conducted of people with AF who had received rate- or rhythm-control medications with or without catheter ablation. Propensity score matching was used to account for a wide range of differences in characteristics including age, sex, ethnicity, comorbidities, and cardiovascular medication use.
After propensity score matching, catheter ablation was associated with a significantly lower risk of dementia and mortality compared with the administration of rhythm or rate control medications. The associations persisted in an additional subgroup analysis examining groups by characteristics including age, sex, comorbidities, and for people receiving OCPs during follow-up. Limitations of the study, including lack of data on ablation success, should be considered and addressed in future studies.
Key points
- It has not been previously determined whether the association between catheter ablation and a lower risk of dementia remains significant for different subgroups of patients.
- In this large study of more than 40,000 people with atrial fibrillation after propensity score matching, catheter ablation was associated with a lower risk of dementia and the association remained significant in all subgroups examined.
- Limitations, including lack of data on ablation success, should be kept in mind when interpreting the findings.
Why is this document important?
This study confirms the lower risk of dementia and mortality with catheter ablation regardless of age, sex, comorbidities, and use of oral anticoagulants. The lower risk of dementia and mortality could be an important consideration when determining appropriate patient-centered rhythm control strategies for patients with atrial fibrillation.
Comments
Does catheter ablation reduce the risks of dementia and mortality in all groups of older adults with atrial fibrillation?
Previous studies have shown a link between catheter ablation and a lower risk of dementia and premature death in patients with atrial fibrillation. It is unclear whether associations between catheter ablation and lower risk of dementia and mortality hold among different subgroups of patients stratified by age, sex, comorbidities, and medication use.
Now, a large study published in the Journal of the American Geriatrics Society that included more than 40,000 people with atrial fibrillation who were followed for at least five years found that catheter ablation is actually associated with lower risks of these outcomes across all types. of patients.
In the study, the risk of dementia was on average about 48% lower in patients who underwent catheter ablation compared to those who did not. The catheter ablation group also had a lower risk of death from any cause. These associations remained in subgroup analyzes in people aged 65 to 79 years; age ≥80 years; males; females; participants who received oral anticoagulants during follow-up; participants with different types of atrial fibrillation; and participants with and without hypertension, diabetes, ischemic stroke, chronic kidney disease, and heart failure.
“The association between atrial fibrillation and an increased risk of dementia is important and strategies to reduce this risk deserve attention. "In our large study, people with atrial fibrillation had a lower risk of dementia if they underwent catheter ablation, and this held regardless of age, sex, and other health conditions," said corresponding author Stephanie Harrison, BSc. (Hons), MSc, PhD. , from the University of Liverpool. “This could be an important consideration when determining appropriate treatment options for patients with atrial fibrillation.”
Final message : 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. More studies are required that include data on ablation success. |
