Heart Failure
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A large study finds that catheter ablation is linked to almost 50% lower risk of dementia and lower deaths in all types of patients with atrial fibrillation.

The research was reported in the Journal of the American Geriatrics Society. It included more than 40,000 individuals with atrial fibrillation (AF) who were followed for at least five years.

In this study, the risk of dementia was on average approximately 48% lower in patients who underwent catheter ablation compared with those who did not. The catheter ablation group also had a lower risk of death from any cause.

These associations remained in subgroup analyses in individuals aged 65–79 years; aged ≥80 years; males; females; participants who received oral anticoagulant medications during follow-up; participants with different types of atrial fibrillation; and participants with and without hypertension, diabetes, ischemic stroke, chronic kidney disease, and heart failure.

The numbers of people with AF are predicted to increase from an estimated 2.6 million in 2010 to 12.1 million by 2030 in the United States alone. Dementia is also predicted to rise to over nine million people in the United States, and 83 million worldwide by 2030.

There has long been an observed association between AF and a higher risk of cognitive impairment and dementia. Furthermore, large population-based cohort studies have suggested the association between AF and higher risk of dementia is independent of the known higher risk of stroke in AF patients.

Catheter ablation may be used as part of AF management to restore and maintain sinus rhythm. Randomized controlled trials have shown catheter ablation is well-tolerated to treat symptomatic AF in patients who have not responded to antiarrhythmic drugs.

Previous studies have shown a link between catheter ablation and a lower risk of dementia and premature death for patients with atrial fibrillation. Previous observational research in Korea, for example, has suggested catheter ablation in 11,726 people with AF was associated with a reduced risk of dementia, compared to antiarrhythmic or rate-control drugs alone.

Ablation involves a flexible wire that is inserted into a blood vessel in the groin and guided to the heart where it destroys tissue that is causing rapid and irregular heartbeats.

It been unclear if the associations between catheter ablation and lower dementia and mortality risks hold among different subgroups of patients stratified by age, sex, comorbidities, and medication use.

“The association between atrial fibrillation and higher risk of dementia is important, and strategies to lower this risk deserve attention. In our large study people with atrial fibrillation had a lower risk of dementia if they had catheter ablation, and this was upheld irrespective of age, sex, and other health conditions,” said corresponding author Stephanie Harrison, PhD, of the University of Liverpool.

She added that, “This could be an important consideration when determining appropriate treatment options for patients with atrial fibrillation.”

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