RF Ablation or Drugs for Afib: Choice May Matter for Cognitive Outcomes

BOSTON — Individuals with atrial fibrillation (Afib) who had undergone radiofrequency (RF) catheter ablation were significantly less likely to develop clinically relevant cognitive impairment than Afib patients managed with drugs, researchers reported.

In a prospective observational study called SAGE-AF, odds that cognitive impairment would appear within 2 years of enrollment were 36% lower among Afib patients with a history of RF ablation, relative to medically managed participants (adjusted OR 0.64, 95% CI 0.46-0.88), according to Bahadar Singh Srichawla, DO, MS, of the University of Massachusetts Chan Medical School in Worcester.

Rates of hemorrhagic and ischemic events did not differ between groups, according to an abstract of the study, slated to be presented here next week at the American Academy of Neurology’s (AAN) annual meeting.

“Previous studies have found that people with arrhythmias may have long-term thinking and memory problems due to how this condition may affect the blood flow to the brain,” Srichawla explained in an AAN press release issued prior to the conference. An unanswered question, however, was whether different forms of Afib treatment vary in their neurological outcomes.

The current study is an outgrowth of the SAGE-AF program, which enrolled more than 1,200 older Afib patients from 2016 to 2018 with the goal of finding relationships between clinical outcomes and factors recommended to be evaluated in standard geriatric exams. These factors included not only cognitive function but also frailty, depression, social isolation, and hearing and vision impairments. Participants were recruited from clinics in Massachusetts and Georgia.

For the analysis, Srichawla and colleagues identified 193 cohort members who had undergone RF ablation prior to enrollment and compared them to 694 others who received oral anticoagulants. Development of cognitive impairment — defined as a Montreal Cognitive Assessment score of 23 or less — over the 2 years following enrollment was the primary outcome tracked in the study.

Mean age in this subcohort was 75, just under half were women, and 87% were white. Those with the history of RF ablation differed somewhat from the medically managed group: more of the former had persistent Afib at enrollment and had also received an implanted cardiac device. Statistical adjustments were taken for these factors as well as for the presence of other cardiovascular diagnoses, sleep apnea, and kidney impairment.

Srichawla and colleagues also looked at whether onset of cognitive impairment differed between the types of drugs used in the medically managed group — specifically, warfarin versus other agents, including newer ones that require less ongoing monitoring and dose adjustment. No significant difference was seen.

However, the data did not include measurements of cerebral blood flow, and therefore the researchers couldn’t shed light on the underlying question of whether the lessened risk of cognitive impairment could be attributed to differences in such effects from treatment.