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Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers
Agata Sularz1, Alejandra Chavez-Ponce1, Ghasaq Saleh1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Moderate sedation (MS) improved cognitive function in elderly patients undergoing left atrial appendage occlusion (LAAO), unlike general anesthesia (GA). This study highlights the impact of anesthesia choice on cognitive outcomes in LAAO procedures.
Area of Science:
- Cardiology
- Neurology
- Anesthesiology
Background:
- Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography for left atrial appendage occlusion (LAAO).
- General anesthesia (GA) may cause cognitive impairment in elderly patients undergoing LAAO.
Purpose of the Study:
- To investigate the effect of anesthesia method (GA vs. moderate sedation [MS]) on cognitive function in patients undergoing LAAO.
- To utilize a novel digital oculomotor biomarker to assess cognitive changes.
Main Methods:
- Prospective enrollment of patients undergoing LAAO at two centers (GA and MS).
- Cognitive function assessed using the ViewMind system (eye-tracking) at baseline, 6 hours, and 45 days post-procedure.
- Oculomotor tests (Go/No Go, N-Back) evaluated cognitive differences within and between groups.
Main Results:
- Patients under MS showed significant long-term improvements in working memory, processing speed, and sustained attention (N-Back task).
- No significant cognitive differences were observed in the GA group over the study period.
- Forty patients (20 per group) completed the study.
Conclusions:
- Oculomotor metrics related to memory improved post-LAAO in the MS group but not the GA group.
- Sedation strategies appear to have a differential impact on cognitive function in elderly patients undergoing LAAO.
- This study provides proof-of-concept for using oculomotor biomarkers to assess cognitive effects of anesthesia in LAAO.
Background:
Intracardiac echocardiography guidance has emerged as a feasible alternative to transesophageal echocardiography in guiding left atrial appendage occlusion (LAAO). A proposed advantage of this approach is the avoidance of cognitive impairment associated with general anesthesia (GA) in elderly patients.
Objectives:
We studied the effect of anesthesia method (GA vs moderate sedation [MS]) on cognitive function using a novel digital oculomotor biomarker.
Methods:
Patients undergoing LAAO were prospectively enrolled at 2 medical centers (GA center and MS center). Cognitive function was assessed at baseline (V1), 6 hours post-LAAO (V2), and at 45 days (V3) using the ViewMind system, which consists of a head-mounted device with eye-tracking capabilities. We examined differences in cognitive function as measured by 2 oculomotor tests (Go/No Go and N-Back), within each group between V1 vs V2 and V1 vs V3.
Results:
Forty patients (20 in each group: GA and MS) were enrolled. Patients in the MS group showed significant long-term (V1 vs V3) improvement in working memory (Δ n complete sequences, P = 0.005), processing speed (Δ n wrong fixations, P = 0.050), and sustained attention (gazing recognition (ms), P = 0.010), as measured by the N-Back task while there were no differences in the GA group (P = 0.180 for Δ n complete sequences, P = 0.410 for Δ n wrong fixations on hitbox, and P = 0.310 gazing recognition [msec]).
Conclusions:
Memory-based oculomotor metrics improved after the procedure in patients undergoing LAAO under MS but not within the GA group. This proof-of-concept study supports a differential impact of sedation strategies on cognitive function in elderly patients undergoing LAAO.
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