Catheter ablation and lower risk of incident dementia and mortality in older adults with atrial fibrillation

• Published in: Journal of the American Geriatrics Society (JAGS) 2023-11, Vol.71 (11), p.3357-3366
• Main Authors: Harrison, Stephanie L., Buckley, Benjamin J. R., Austin, Philip, Lane, Deirdre A., Lip, Gregory Y. H.
• Format: Article
• Language: English
• Subjects: Ablation; Cardiac arrhythmia; Cardiovascular diseases; Catheters; Confidence intervals; Congestive heart failure; Dementia; Dementia disorders; Diabetes mellitus; Ejection fraction; Elder care; Fibrillation; Heart diseases; Heart failure; Ischemia; Kidney diseases; Morbidity; Mortality; Older people; Public health; Radiofrequency ablation; Renal failure
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18538

BackgroundAtrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co‐morbidity status, and oral anticoagulant use.MethodsThe research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity‐score matched cohorts.ResultsAfter propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co‐morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45–0.61). The catheter ablation cohort also had a lower risk of all‐cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55–0.61). These associations remained in subgroup analyses in individuals aged 65–79 years, ≥80 years, males, females, participants who received OACs during follow‐up, participants with paroxysmal and non‐paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.ConclusionThe observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient‐centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required.