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Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation.

Caroline Medi1, Lisbeth Evered, Brendan Silbert

  • 1Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.

Journal of the American College of Cardiology
|May 21, 2013
PubMed
Summary
This summary is machine-generated.

Post-operative neurocognitive dysfunction (POCD) occurs in 13-20% of patients after atrial fibrillation (AF) ablation. These cognitive changes, particularly after longer procedures, warrant further investigation into their long-term impact.

Keywords:
ACTAFCERADCHADS(2)CICongestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attackConsortium to Establish a Registry for Alzheimer's DiseaseIQMRIORPAFPOCDPeAFRCIRFASVTablationactivated clotting timeatrial fibrillationconfidence intervalintelligence quotientmagnetic resonance imagingneurocognitive dysfunctionodds ratiooutcomesparoxysmal atrial fibrillationpersistent atrial fibrillationpost-operative cognitive dysfunctionradiofrequency ablationreliable change indexsupraventricular tachycardia

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Area of Science:

  • Cardiology
  • Neurology
  • Medical Procedures

Background:

  • Atrial fibrillation (AF) ablation is effective but carries a small risk of stroke.
  • Silent cerebral infarction is observed in 7-14% of patients post-ablation.
  • The link between cerebral ischemia and post-operative neurocognitive dysfunction (POCD) after AF ablation is not well understood.

Purpose of the Study:

  • To investigate the occurrence of POCD following catheter ablation for atrial fibrillation (AF).
  • To compare POCD rates in patients undergoing ablation for different types of AF and supraventricular tachycardia (SVT).
  • To identify factors associated with POCD after AF ablation.

Main Methods:

  • 150 patients undergoing ablation for paroxysmal AF (PAF), persistent AF (PeAF), or SVT were compared to 30 non-operative AF controls.
  • Eight neuropsychological tests were administered at baseline, 2 days, and 90 days post-procedure.
  • The reliable change index was used to determine POCD.

Main Results:

  • POCD prevalence at 2 days was 28% (PAF), 27% (PeAF), 13% (SVT), and 0% (controls).
  • At 90 days, POCD prevalence was 13% (PAF), 20% (PeAF), 3% (SVT), and 0% (controls).
  • Longer left atrial access time correlated with increased POCD at both 2 and 90 days.

Conclusions:

  • AF ablation is associated with a significant prevalence of POCD, ranging from 13% to 20% at long-term follow-up.
  • These findings are relevant for patients with low CHADS2 scores, representing the majority undergoing AF ablation.
  • The long-term clinical significance of these subtle neurocognitive changes requires further research.