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

Research output: Contribution to journalReview articlepeer-review

Neil Bodagh, Reuben Yap, Irum Kotadia, Iain Sim, Ajay Bhalla, Peter Somerville, Mark O’Neill, Steven E. Williams

Original languageEnglish
Pages (from-to)271-286
Number of pages16
JournalJournal of Interventional Cardiac Electrophysiology
Volume65
Issue number1
DOIs
Accepted/In press2022
PublishedOct 2022

Bibliographical note

Funding Information: This research was supported by the British Heart Foundation (PG/19/44/34368), the British Heart Foundation Centre for Research Excellence at the University of Edinburgh (RE/18/5/34216) and by core funding from the Wellcome/ESPRC Centre for Medical Engineering at King’s College London (WT203148/Z/16/Z). Dr Williams is supported by the British Heart Foundation (FS/20/26/34952). Publisher Copyright: © 2022, The Author(s).

King's Authors

Abstract

Purpose: Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether the restoration of sinus rhythm with catheter ablation may modify this risk. We conducted a systematic review of studies comparing cognitive outcomes following catheter ablation with medical therapy (rate and/or rhythm control) in atrial fibrillation. Methods: Searches were performed on the following databases from their inception to 17 October 2021: PubMed, OVID Medline, Embase and Cochrane Library. The inclusion criteria comprised studies comparing catheter ablation against medical therapy (rate and/or rhythm control in conjunction with anticoagulation where appropriate) which included cognitive assessment and/or a diagnosis of dementia as an outcome. Results: A total of 599 records were screened. Ten studies including 15,886 patients treated with catheter ablation and 42,684 patients treated with medical therapy were included. Studies which compared the impact of catheter ablation versus medical therapy on quantitative assessments of cognitive function yielded conflicting results. In studies, examining new onset dementia during follow-up, catheter ablation was associated with a lower risk of subsequent dementia diagnosis compared to medical therapy (hazard ratio: 0.60 (95% confidence interval 0.42–0.88, p < 0.05)). Conclusion: The accumulating evidence linking atrial fibrillation with cognitive impairment warrants the design of atrial fibrillation treatment strategies aimed at minimising cognitive decline. However, the impact of catheter ablation and atrial fibrillation medical therapy on cognitive decline is currently uncertain. Future studies investigating atrial fibrillation treatment strategies should include cognitive outcomes as important clinical endpoints.

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