Global and Domain-Specific Cognitive Outcomes After Catheter Ablation for Atrial Fibrillation
Sotirios Chiotis, Georgios Giannopoulos, Sofia-Chrysovalantou Zagalioti, Sonia-Evdokia Konstantinidou, Maria-Ioanna Mountourli, Aikaterini Zgouridou, Athanasia Anastasiou, Konstantinos Bakogiannis, Alexandros Evaggeliou, Georgios Sapouridis, Maria Toumpourleka, Constantinos Triantafyllou, Eleni Poptsi, Andreas Symeonidis, Magda Tsolaki, Vassilios VassilikosImportance
Atrial fibrillation (AF) is associated with cognitive impairment, but the cognitive effects of catheter ablation (CA) using contemporary techniques remain uncertain.
Objective
To evaluate changes in global and domain-specific cognitive function after CA for AF.
Design, Setting, and Participants
This prospective cohort study included consecutive patients undergoing CA for AF and a nonablation AF control group at a tertiary university hospital in Greece between January 2022 and June 2024. Cognitive assessments were performed at baseline and at 6-month follow-up.
Exposures
CA using cryoballoon or pulsed field ablation (PFA).
Main Outcomes and Measures
Changes from baseline to 6 months in Montreal Cognitive Assessment (MoCA) scores and the novel REMEDES for Alzheimer (R4Alz) total and subdomain scores. Brain magnetic resonance imaging was performed before and within 48 hours after ablation to detect new cerebral infarcts.
Results
Among 75 patients (40 [53.3%] female) undergoing ablation (mean [SD] age, 61.9 [10.4] years; 54 cryoballoon, 21 PFA) and 40 in a nonablation control group (26 [65.0%] female; mean [SD] age,61.4 [9.2] years), baseline cognitive scores were similar between groups. No new cerebral infarcts were detected after ablation. At 6 months, MoCA scores in the ablation group did not change significantly (mean change, 0.27; 95% CI, −0.08 to 0.62), whereas R4Alz total scores increased (mean change, 2.81; 95% CI, 1.55 to 4.07), mainly associated with gains in short-term working memory and perceptual inhibition. No significant changes were observed in the control group. Compared with the control group, the ablation cohort demonstrated significantly greater improvements in both MoCA (mean difference in change, 0.74; 95% CI, 0.17 to 1.31;
Conclusions and Relevance
In this prospective observational cohort study of 75 patients undergoing CA for AF, ablation was not associated with cognitive decline and was instead associated with modest short-term improvements in selected cognitive domains. Domain-specific assessment detected changes not captured by global cognitive screening, suggesting that modern ablation techniques may be associated with early subtle cognitive gains.