Clinical Research
Heart Rhythm Disorders
Subtle Post-Procedural Cognitive Dysfunction After Atrial Fibrillation Ablation

https://doi.org/10.1016/j.jacc.2013.03.073Get rights and content
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Objectives

This study sought to determine whether post-operative neurocognitive dysfunction (POCD) occurs after ablation for atrial fibrillation (AF).

Background

Ablation for AF is a highly effective strategy; however, the risk of transient ischemic attack and stroke is approximately 0.5% to 1%. In addition, magnetic resonance imaging studies report a 7% to 14% prevalence of silent cerebral infarction. Whether cerebral ischemia results in POCD after ablation for AF is not well established.

Methods

The study included 150 patients; 60 patients undergoing ablation for paroxysmal atrial fibrillation (PAF), 30 patients undergoing ablation for persistent atrial fibrillation (PeAF), and 30 patients undergoing ablation for supraventricular tachycardia (SVT) were compared with a matched nonoperative control group of patients with AF awaiting radiofrequency ablation (n = 30). Eight neuropsychological tests were administered at baseline and at 2 days and 90 days post-operatively. The tests were administered at the same time points to the nonoperative control group. The reliable change index was used to calculate POCD.

Results

The prevalences of POCD at day 2 post-procedure were 28% in patients with PAF, 27% in patients with PeAF, 13% in patients with SVT, and 0% in control patients with AF (p = 0.007). At day 90, the prevalences of POCD were 13% in patients with PAF, 20% in patients with PeAF, 3% in patients with SVT, and 0% in control patients with AF (p = 0.03). When analyzing the 3 procedural groups together, 29 of 120 patients (24%) manifested POCD at day 2 and 15 of 120 patients (13%) at day 90 post-procedure (p = 0.029). On univariate analysis, increasing left atrial access time was associated with POCD at day 2 (p = 0.04) and day 90 (p = 0.03).

Conclusions

Ablation for AF is associated with a 13% to 20% prevalence of POCD in patients with AF at long-term follow-up. These results were seen in a patient population with predominant CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) scores of 0 to 1, representing the majority of patients undergoing ablation for AF. The long-term implications of these subtle changes require further study.

Key Words

ablation
atrial fibrillation
neurocognitive dysfunction
outcomes

Abbreviations and Acronyms

ACT
activated clotting time
AF
atrial fibrillation
CERAD
Consortium to Establish a Registry for Alzheimer's Disease
CHADS2
Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack
CI
confidence interval
IQ
intelligence quotient
MRI
magnetic resonance imaging
OR
odds ratio
PAF
paroxysmal atrial fibrillation
PeAF
persistent atrial fibrillation
POCD
post-operative cognitive dysfunction
RCI
reliable change index
RFA
radiofrequency ablation
SVT
supraventricular tachycardia

Cited by (0)

Drs. Medi and Teh are supported by a medical postgraduate scholarship from the National Heart Foundation of Australia; and was a recipient of a cardiovascular and lipid research grant from Pfizer. Prof. Kistler is supported in part by the Victorian Government's Operational Infrastructure Support Program. Prof. Kalman receives research and fellowship support from St. Jude Medical, Medtronic, and Biosense Webster. Dr. Medi received the Eric N. Prystowsky Fellow Clinical Research Award at the Heart Rhythm Society Meeting in Denver, Colorado, in 2010 for research presented in this paper. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.