Abstract
Introduction: Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation impacts cognitive function. Catheter ablation for AF prolongs the duration of sinus rhythm, thereby improving the quality of life and theoretically reducing the risk of dementia. Objective: We investigated the association of catheter ablation for AF with the occurrence of any dementia. Methods: A systematic search using electronic databases was performed from inception until January 15, 2021. Mantel-Haenszel risk ratio (RR) random-effects model (DerSimonian and Laird method) was used to summarize data. The primary outcome was occurrence of dementia during the follow-up period. Statistical analysis was performed using a meta-package for R version 4.0 and Rstudio version 1.2. Results: A total of 3 eligible studies (retrospective and prospective) consisting of 34,360 patients [Catheter ablation = 10,862 and medical therapy (antiarrhythmic drugs or rate-control drugs) = 23,498] were included in the meta-analysis. Patients in the ablation group were younger compared to medical therapy (59.6 ± 10.4 vs 60.3 ± 10.6 years; p<0.001). Hypertension (55% vs 54.4%, p = 0.31), heart failure (23.7% vs 22.1%, p = 0.001), diabetes (14% vs 15.2%, p = 0.004), cerebrovascular accident (11% vs 10%, p = 0.005) and myocardial infarction (7.5% vs 6.5%, p<0.001) were most common comorbidities, respectively. There was a lower incidence of dementia in AF patients treated with catheter ablation compared to medical therapy (2% vs 3.5%, RR 0.39, 95% CI 0.22-0.70, p<0.01) during a mean follow-up period of 5.44 years. Conclusion: AF ablation patients have a significantly lower risk of dementia in comparison to AF patients without ablation.
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