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[Preprint]. 2023 Nov 20:2023.11.20.23298768.
doi: 10.1101/2023.11.20.23298768.

Is Catheter Ablation Associated with Preservation of Cognitive Function? An Analysis From the SAGE-AF Observational Cohort Study

Bahadar S Srichawla  1 , Alexander P Hamel  2 , Philip Cook  2 , Rozaleen Aleyadeh  1 , Darleen Lessard  2 , Edith M Otabil  2 , Jordy Mehawej  2 , Jane S Saczynski  2 , David D McManus  2 , Majaz Moonis  1
Affiliations

Is Catheter Ablation Associated with Preservation of Cognitive Function? An Analysis From the SAGE-AF Observational Cohort Study

Bahadar S Srichawla et al. medRxiv. .

Update in

Abstract

Objectives: To examine the associations between catheter ablation treatment (CA) versus medical management and cognitive impairment among older adults with atrial fibrillation (AF).

Methods: Ambulatory patients who had AF, were ≥ 65-years-old, and were eligible to receive oral anticoagulation could be enrolled into the SAGE (Systematic Assessment of Geriatric Elements)-AF study from internal medicine and cardiology clinics in Massachusetts and Georgia between 2016 and 2018. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool at baseline, one-, and two years. Cognitive impairment was defined as a MoCA score ≤ 23. Multivariate-adjusted logistic regression of longitudinal repeated measures was used to examine associations between treatment with CA vs. medical management and cognitive impairment.

Results: 887 participants were included in this analysis. On average, participants were 75.2 ± 6.7 years old, 48.6% women, and 87.4% white non-Hispanic. 193 (21.8%) participants received a CA before enrollment. Participants who had previously undergone CA were significantly less likely to be cognitively impaired during the two-year study period (aOR 0.70, 95% CI 0.50-0.97) than those medically managed (i.e., rate and/or rhythm control), even after adjusting with propensity score for CA. At the two-year follow-up a significantly greater number of individuals in the non-CA group were cognitively impaired (MoCA ≤ 23) compared to the CA-group (311 [44.8%] vs. 58 [30.1%], p=0.0002).

Conclusions: In this two-year longitudinal prospective cohort study participants who underwent CA for AF before enrollment were less likely to have cognitive impairment than those who had not undergone CA.

Keywords: ablation; atrial fibrillation; cognitive function; hemorrhage; infarction; stroke.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors have no reported conflicts of interest.

Figures

Figure 1:
Figure 1:
Percentage of individuals in the CA and non-CA groups with cognitive impairment defined by a MoCA ≤ 23 at baseline, one-, and two-year end points. At baseline (p = 0.06) and at one-year (p = 0.09) no statistically significant difference in cognitive impairment was observed between both groups. At year two a significant proportion of individuals in the non-CA group are cognitively impaired compared to the CA group (p= 0.0002).
Figure 2:
Figure 2:
MoCA score at baseline, one, and two-year endpoints in both the CA and non-CA groups. A statistically significant drop in the MoCA score was observed at the two-year end point compared to baseline in the non-CA group (p <0.0001).
See this image and copyright information in PMC

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