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. 2023 May 19;25(5):euad109.
doi: 10.1093/europace/euad109.

Ablation of atrial fibrillation and dementia risk reduction during long-term follow-up: a nationwide population-based study

Guan-Yi Li  1   2 , Yun-Yu Chen  1   2   3   4   5 , Yenn-Jiang Lin  1   2 , Kuo-Liong Chien  4 , Yu-Cheng Hsieh  2   3 , Fa-Po Chung  1   2 , Li-Wei Lo  1   2 , Shih-Lin Chang  1   2 , Tze-Fan Chao  1   2 , Yu-Feng Hu  1   2 , Chin-Yu Lin  1   2 , Shih-Ann Chen  1   2   3   6
Affiliations

Ablation of atrial fibrillation and dementia risk reduction during long-term follow-up: a nationwide population-based study

Guan-Yi Li et al. Europace. .

Abstract

Aims: This study investigated the epidemiological characteristics of new-onset dementia in patients with atrial fibrillation (AF) and the association of catheter ablation with different subtypes of dementia.

Methods and results: We conducted a population-based, retrospective cohort study using data from the Taiwan National Health Insurance Research Database. In total, 136 774 patients without a history of dementia were selected after 1:1 propensity score matching based on age (with AF vs. without AF). A competing risk model was used to investigate the three subtypes of dementia: Alzheimer's disease, vascular dementia, and other/mixed dementia. Inverse probability of treatment weighting (IPTW) was performed to minimize the impact on dementia risk due to the imbalanced baseline characteristics. After a median follow-up period of 6.6 years, 8704 events of new-onset dementia occurred. Among all AF patients developing dementia, 73% were classified as having Alzheimer's disease, 16% as having vascular dementia, and 11% as having other/mixed dementia. The cumulative incidence of dementia in AF patients was higher than those without AF (log-rank test: P < 0.001 for both before and after IPTW). In patients with AF undergoing catheter ablation, the total dementia risk decreased significantly [P = 0.015, hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.58-0.94] after multivariable adjustment, but not for the subtype of vascular dementia (P = 0.59, HR: 0.86, 95% CI: 0.49-1.50).

Conclusion: Patients with AF have a higher incidence of all types of dementia, including Alzheimer's disease, vascular dementia, and a mixed type of dementia. Alzheimer's disease is less likely to occur in patients with AF undergoing catheter ablation.

Keywords: Alzheimer’s disease; Atrial fibrillation; Catheter ablation; Dementia; Vascular dementia.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Study flow chart. AF, atrial fibrillation.
Figure 2
Figure 2
The proportions of patients with various subtypes of dementia in different study groups before and after IPTW. (A) Non-AF controls, (B) all AF patients, (C) AF-no ablation, (D) AF-ablation. AF, atrial fibrillation; IPTW, inverse probability of treatment weighting.
Figure 3
Figure 3
Survival curve of freedom from total dementia before and after IPTW. (A) Non-AF controls vs. all AF patients; (B) Non-AF controls vs. AF-no ablation vs. AF-ablation. AF, atrial fibrillation; IPTW, inverse probability of treatment weighting.
Figure 4
Figure 4
Incidence rates of various subtypes of dementia in different study groups before and after IPTW. (A) between non-AF controls and all AF patients; (B) only in AF patients (AF ablation vs. no AF ablation). AF, atrial fibrillation; IPTW, inverse probability of treatment weighting.
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