Atrial fibrillation ablation is better than medication?

Atrial fibrillation ablation is better than medication? Atrial fibrillation ablation is associated with a reduced risk of dementia? better than medication?

Atrial fibrillation is a common type of tachyarrhythmia and has become one of the serious burdens of international public health. In the next few years, the age distribution of patients with atrial fibrillation in developed countries will change, and the prevalence of atrial fibrillation in the elderly will continue to increase. Worldwide, approximately 40 million people suffer from dementia, and this number will continue to rise as the elderly population in an aging society increases.

Atrial fibrillation is a common type of tachyarrhythmia and has become one of the serious burdens of international public health. In the next few years, the age distribution of patients with atrial fibrillation in developed countries will change, and the prevalence of atrial fibrillation in the elderly will continue to increase. Worldwide, approximately 40 million people suffer from dementia, and this number will continue to rise as the elderly population in an aging society increases.

2006-2015, the prevalence of atrial fibrillation by age group in Korea

1. Atrial fibrillation and dementia

Although the pathophysiological mechanism of dementia is not yet clear, more and more evidence has shown that atrial fibrillation may be one of the important risk factors for cognitive dysfunction and dementia. A previous Rotterdam study published in the “Stroke” magazine showed that the risk of cognitive dysfunction and dementia in subjects with atrial fibrillation was about twice that of subjects without atrial fibrillation, confirming atrial fibrillation It is independently related to cognitive decline or increased risk of dementia. The corrected data is as follows:

2. Catheter ablation for atrial fibrillation

Compared with antiarrhythmic drug (AAD) therapy, catheter ablation reduces the number of acute attacks of atrial fibrillation and prolongs the sinus rhythm interval, thereby improving the quality of life of patients. In a randomized controlled study published in JAMA in 2019, the frequency of atrial fibrillation and quality of life in the catheter ablation group and the drug treatment group were compared, highlighting the clinical advantages of catheter ablation. Follow-ups were conducted at 3, 12, 24, 36, 48, and 60 months. The comparison of the percentages of the number of people with atrial fibrillation in the two groups within the month before the follow-up at each time period is as follows:

3. The association between atrial fibrillation ablation and dementia

The relationship between catheter ablation and dementia is not yet clear. In the “2017 HRS /EHRA /ECAS / APHRS /SOLAECE Expert Consensus on Atrial Fibrillation Catheter and Surgical Ablation”, a study in the “Journal of the American College of Cardiology” was cited to point out atrial fibrillation catheter ablation and cognitive function The decline is related to acute brain injury.

The study reported that at 90 days after surgery, 13% of patients who received paroxysmal atrial fibrillation (PAF) ablation had mild postoperative neurocognitive dysfunction (POCD), and 20% received ablation of persistent atrial fibrillation (PeAF) Of patients with POCD, the incidence of cognitive dysfunction in the non-surgical AF control group was 0. The relevant statistics are as follows:

In contrast, a prospective case-control study published in Circulation: Arrhythmia and Electrophysiology in 2019 used the Montreal Cognitive Assessment Scale to assess the cognition of patients in the atrial fibrillation ablation group and the drug treatment group Features.

The 1-year follow-up results showed that the cognitive score of the ablation group was significantly higher than that of the drug treatment group, and the risk of dementia was relatively lower. The comparison of the Montreal Cognitive Assessment Scale scores of the two groups of patients at baseline, 3 months, and 1 year after surgery is as follows:

4. New research: ablation of atrial fibrillation is associated with reduced risk of dementia

In view of the differences in the conclusions of the above new and old studies, Daehoon Kim, a cardiologist at the Yonsei University School of Medicine in South Korea, compared various pathogenic factors of dementia in patients with atrial fibrillation in the catheter ablation and drug treatment groups, and published the relevant results in the European Heart Journal” magazine.

The researchers used the National Health Insurance Agency (NHIS) database of South Korea, and through various screenings, finally selected 9119 patients with atrial fibrillation undergoing ablation and 17,978 patients with medication-treated atrial fibrillation from 2005 to 2015 for comparative analysis. The risk time was calculated from the patient after ablation or other treatments such as the first receiving of drugs, and propensity score matching was used to correct the imbalance of baseline data between groups.

During a median follow-up of 52 months, 164 cases of dementia occurred in the ablation group and 308 cases in the non-ablation treatment (including drug treatment) group. The incidence of dementia in the two groups was 6.1% and 9.1%, respectively. Compared with patients in the non-ablation treatment group, patients in the catheter ablation group had a lower risk of dementia (HR 0.73, 95% CI 0.58–0.93), and the risk of dementia subtypes Alzheimer’s disease and vascular dementia were significantly lower . After excluding patients with stroke, the correlation between ablation and the risk of dementia still exists (HR 0.76, 95% CI 0.61-0.95), and there is no significant difference in Alzheimer’s disease.

When only comparing the ablation group and the antiarrhythmic drug (AAD) group, the risk of dementia and vascular dementia in the ablation group was significantly lower (P<0.05), and there was no significant difference in Alzheimer’s disease. After excluding stroke patients, there was no significant difference between the two groups in the incidence of dementia and dementia subtypes. See the figure below for details:

When only comparing the ablation group and the rate-control drug group, the risk of dementia and vascular dementia in the ablation group were significantly lower (P<0.05), and there was no significant difference in Alzheimer’s disease. After excluding stroke patients, there was no significant difference between the two groups in the incidence of dementia and dementia subtypes. Similar to the results of the antiarrhythmic drug (AAD) group.

Further analysis shows that when the ablation is successful, the difference between the ablation group and the drug treatment group is more obvious, while in the case of the first ablation failure, there is no significant difference.

5. Editorial comments

Professor A. John Camm of the University of London published an editorial comment in the European Heart Journal, arguing that the above-mentioned study by Daehoon Kim et al. in South Korea provided a basis for the relationship between atrial fibrillation and dementia and ablation treatment of atrial fibrillation and dementia. Correlation provides more evidence.

However, a large number of existing studies are mostly observational studies or retrospective analysis, and there are also many uncertain confounding factors. In the future, it is necessary to conduct more randomized controlled clinical trials to provide more sufficient verification evidence.

(source:chinanet, reference only)

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