Early versus delayed catheter ablation in patients with atrial fibrillation: impact on dementia risk using a global federated network
A Askarinejad, A G Rigutini, K Ahmadzadeh, S H M Lam, L Serio, M Rossi, C Wang, T Gu, A Mavilakandy, M Alobaida, C becattini, G Y H LipAbstract
Background
Early catheter ablation for atrial fibrillation (AF) has been associated with improved thromboembolic outcomes compared with late ablation; however, whether earlier intervention results in a protective effect against dementia remains unclear.
Objective
To compare dementia risk among patients with AF undergoing early versus delayed ablation following initial diagnosis.
Methods
Two cohorts were evaluated using the TriNetX platform: (i) patients with a first diagnosis of paroxysmal AF who underwent ablation within 1 year of diagnosis (early ablation group) versus those who underwent ablation between 1 and 3 years after diagnosis (intermediate ablation group); and (ii) early ablation group versus ablation between 3 and 5 years after diagnosis (late ablation group). The primary objective was the 3-year risk of incident dementia. Secondary objectives were the risk of Alzheimer’s disease, vascular dementia, and dementia without behavioural disturbance.
Results
Before propensity score matching (PSM), patients in early ablation group (n=21,009, 33.6% female), compared to intermediate ablation group (n=12,753, 35.1% female) and late ablation group (n=9,881, 35.5% female) were younger, with fewer comorbidities such as hypertension and stroke. After PSM, patients in early ablation group compared with intermediate ablation group (n=12,146), showed a non-significant lower risk of dementia (HR: 0.74, 95% CI: 0.49-1.12) and Alzheimer’s disease (HR: 0.83, 95% CI 0.45-1.53). After PSM, patients in early ablation group compared to late ablation group (n=9,152), showed significantly lower risk of dementia (HR: 0.43, 95% CI: 0.28-0.65) and Alzheimer’s disease (HR: 0.45, 95% CI: 0.24-0.86).
Conclusion
Early ablation within 1 year of AF diagnosis, compared with delayed ablation, was associated with a reduced risk of 3-year dementia and Alzheimer’s disease, highlighting the potential cognitive benefits of early rhythm control strategies.Figure 1Figure 2