Ablation for Atrial Fibrillation May Protect the Aging Brain

Treating atrial fibrillation with catheter ablation in addition to medical management may offer greater protection against cognitive impairment than medical management alone, new research suggests.

Investigators found adults who had previously undergone catheter ablation were significantly less likely to be cognitively impaired during the 2-year study period, compared with those who receive medical management alone.

"Catheter ablation is intended to stop atrial fibrillation and restore the normal rhythm of the heart. By doing so, there is an improved cerebral hemodynamic profile," Bahadar S. Srichawla, DO, Department of Neurology, University of Massachusetts Chan Medical School in Worcester, told Medscape Medical News.

"Thus, long-term cognitive outcomes may be improved due to improved blood flow to the brain by restoring the normal rhythm of the heart," he added.

The findings were presented today at the American Academy of Neurology (AAN) 2023 Annual Meeting.

Heart–Brain Connection

The study involved 887 older adults (mean age 75; 49% women) with atrial fibrillation (AF) participating in the SAGE-AF (Systematic Assessment of Geriatric Elements) study.

A total of 193 (22%) participants underwent catheter ablation prior to enrollment. These individuals more frequently had an implantable cardiac device (46% vs 28%, P < .001) and persistent AF (31% vs 23%, P < .05).

Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool at baseline and 1 and 2 years, with cognitive impairment defined as a MoCA score ≤ 23.

Individuals who had catheter ablation had an average MoCA score of 25 compared with an average score of 23 in those who didn't have catheter ablation.

After adjusting for potential confounding factors such as heart disease, renal disease, sleep apnea, and AF risk score, those who underwent catheter ablation were 36% less likely to develop cognitive impairment over 2 years than those who were treated only with medication (adjusted odds ratio, 0.64; 95% CI, 0.46 - 0.88).

During his presentation, Srichawla noted there is a hypothesis that individuals who are anticoagulated with warfarin may be prone to cerebral microbleeds and may be more cognitively impaired over time.

However, in a subgroup analysis, "cognitive function was similar at 2-year follow-up in those anticoagulated with warfarin compared to all other anticoagulants. However, it should be noted that in this study, a direct head-to-head comparison was not done," Srichawla told attendees.

"In patients with atrial fibrillation, catheter ablation should be discussed as a potential treatment strategy, particularly in patients who have or are at risk for cognitive decline and dementia," Srichawla told Medscape Medical News.

Intriguing Findings

Commenting on the research for Medscape Medical News, Percy Griffin, PhD, Alzheimer's Association director of scientific engagement, said the study is "intriguing and adds to what we know from previous research connecting cardiovascular and cognitive health."

"However, there are limitations to this study," Griffin said, "including its predominantly White cohort and the use of only neuropsychiatric testing to diagnose dementia. More research is needed to fully understand the impact of atrial fibrillation on cognitive outcomes in all people."

"It's well known that the heart and the brain are intimately connected. Individuals experiencing any cardiovascular issues should speak to their doctor," Griffin added.

Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, agreed.

"If you ever get up too quickly and feel woozy, that is your brain not getting enough blood flow and you are getting all the warning signs to correct that — or else! Similarly, with atrial fibrillation, the heart is contracting, but not effectively pumping blood to the brain," he told Medscape Medical News.

"This line of research shows that correcting the abnormal heart rhythm by zapping the faulty circuit with a catheter is actually better for your brain health than just taking medications alone," added Lakhan, who was not involved with the study.

The study had no commercial funding. Srichawla, Griffin and Lakhan report no relevant financial relationships.

American Academy of Neurology (AAN) 2023 Annual Meeting: Abstract 68. Presented April 24, 2023.

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Image 1: Dr Bahadar Srichawla

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Cite this: Ablation for Atrial Fibrillation May Protect the Aging Brain - Medscape - Apr 24, 2023.