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. 2024 Jan 5:14:1302020.
doi: 10.3389/fneur.2023.1302020. eCollection 2023.

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. Front Neurol. .

Abstract

Objectives: To examine the associations between catheter ablation treatment (CA) vs. 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, 1-, and 2 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 2-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 2-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).

Conclusion: In this 2-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: MoCA; ablation; atrial fibrillation; cognitive decline; cognitive function; dementia; infarction; stroke.

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Conflict of interest statement

DM has received research support from Bristol Myers Squibb-Pfizer, Boehringer Ingelheim, and Fitbit, and has received consulting fees from Fitbit, Heart Rhythm Society, Avania, Venturewell, and NAMSA which are not associated with the research presented in this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict 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, 1-, and 2-year end points. At baseline (p = 0.06) and at 1-year (p = 0.09) no statistically significant difference in cognitive impairment was observed between both groups. At year 2, 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, 1 and 2-year endpoints in both the CA and non-CA groups. A statistically significant drop in the MoCA score was observed at the 2-year end point compared to baseline in the non-CA group (p < 0.0001).
See this image and copyright information in PMC

Update of

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