Kim Daehoon, Yang Pil-Sung, Sung Jung-Hoon, Jang Eunsun, Yu Hee Tae, Kim Tae-Hoon, Uhm Jae-Sun, Kim Jong-Youn, Pak Hui-Nam, Lee Moon-Hyoung, Lip Gregory Y H, Joung Boyoung
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Cardiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
Eur Heart J. 2020 Dec 14;41(47):4483-4493. doi: 10.1093/eurheartj/ehaa726.
Accumulating evidence shows that atrial fibrillation (AF) is associated with an increased risk of dementia. Catheter ablation for AF prolongs the duration of sinus rhythm, thereby improving the quality of life. We investigated the association of catheter ablation for AF with the occurrence of dementia.
Using the Korean National Health Insurance Service database, among 194 928 adults with AF treated with ablation or medical therapy (antiarrhythmic or rate control drugs) between 1 January 2005 and 31 December 2015, we studied 9119 patients undergoing ablation and 17 978 patients managed with medical therapy. The time-at-risk was counted from the first medical therapy, and ablation was analysed as a time-varying exposure. Propensity score-matching was used to correct for differences between the groups. During a median follow-up of 52 months, compared with patients with medical therapy, ablated patients showed lower incidence and risk of overall dementia (8.1 and 5.6 per 1000 person-years, respectively; hazard ratio 0.73, 95% confidence interval 0.58-0.93). The associations between ablation and dementia risk were consistently observed after additionally censoring for incident stroke (hazard ratio 0.76, 95% confidence interval 0.61-0.95) and more pronounced in cases of ablation success whereas no significant differences observed in cases of ablation failure. Ablation was associated with lower risks of dementia subtypes including Alzheimer's disease and vascular dementia.
In this nationwide cohort of AF patients treated with catheter ablation or medical therapy, ablation was associated with decreased dementia risk. This relationship was evident after censoring for stroke and adjusting for clinical confounders.
越来越多的证据表明，心房颤动（AF）与痴呆风险增加有关。房颤导管消融可延长窦性心律持续时间，从而改善生活质量。我们研究了房颤导管消融与痴呆发生之间的关联。
利用韩国国民健康保险服务数据库，在2005年1月1日至2015年12月31日期间接受消融或药物治疗（抗心律失常或心率控制药物）的194928例成年房颤患者中，我们研究了9119例接受消融的患者和17978例接受药物治疗的患者。风险时间从首次药物治疗开始计算，消融作为一个随时间变化的暴露因素进行分析。采用倾向评分匹配法校正组间差异。在中位随访52个月期间，与药物治疗患者相比，接受消融的患者总体痴呆的发病率和风险较低（分别为每1000人年8.1例和5.6例；风险比0.73，95%置信区间0.58-0.93）。在对新发卒中进行额外审查后，一致观察到消融与痴呆风险之间的关联（风险比0.76，95%置信区间0.61-0.95），在消融成功的病例中更为明显，而在消融失败的病例中未观察到显著差异。消融与包括阿尔茨海默病和血管性痴呆在内的痴呆亚型风险较低有关。
在这个全国性的接受导管消融或药物治疗的房颤患者队列中，消融与痴呆风险降低有关。在对卒中进行审查并调整临床混杂因素后，这种关系很明显。
