导管消融对房颤患者认知功能的影响：一项随机对照试验。

Impact of Catheter Ablation on Cognitive Function in Atrial Fibrillation: A Randomized Control Trial.

机构信息

Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia.

Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Clinical Psychology, Royal Women's Hospital, Melbourne, Australia.

出版信息

JACC Clin Electrophysiol. 2023 Jul;9(7 Pt 2):1024-1034. doi: 10.1016/j.jacep.2023.02.020. Epub 2023 May 24.

DOI:10.1016/j.jacep.2023.02.020

PMID:37227345

Abstract

BACKGROUND

Early postoperative cognitive dysfunction (POCD) has been reported following atrial fibrillation (AF) ablation. However, whether POCD is persistent long-term is unknown.

OBJECTIVES

The purpose of this study was to determine if AF catheter ablation is associated with persistent cognitive dysfunction at 12-month follow-up.

METHODS

This is a prospective study of 100 patients with symptomatic AF who failed at least 1 antiarrhythmic drug randomized to either ongoing medical therapy or AF catheter ablation and followed up for 12 months. Changes in cognitive performance were assessed using 6 cognitive tests administered at baseline and during follow-up (3, 6, and 12 months).

RESULTS

A total of 96 participants completed the study protocol. Mean age was 59 ± 12 years (32% women, 46% with persistent AF). The prevalence of new cognitive dysfunction in the ablation arm compared with the medical arm was as follows: at 3 months: 14% vs 2%; P = 0.03; at 6 months: 4% vs 2%; P = NS; and at 12 months: 0% vs 2%; P = NS. Ablation time was an independent predictor of POCD (P = 0.03). A significant improvement in cognitive scores was seen in 14% of the ablation arm patients at 12 months compared with no patients in the medical arm (P = 0.007).

CONCLUSIONS

POCD was observed following AF ablation. However, this was transient with complete recovery at 12-month follow-up.

摘要

背景

据报道，心房颤动（AF）消融术后会出现早期术后认知功能障碍（POCD）。然而，POCD 是否持续存在尚不清楚。

目的

本研究旨在确定 AF 导管消融是否与 12 个月随访时持续的认知功能障碍相关。

方法

这是一项前瞻性研究，共纳入 100 例症状性 AF 患者，这些患者至少使用过 1 种抗心律失常药物治疗但失败，随机分为继续药物治疗或 AF 导管消融组，并随访 12 个月。使用 6 项认知测试在基线和随访期间（3、6 和 12 个月）评估认知功能的变化。

结果

共有 96 名参与者完成了研究方案。平均年龄为 59 ± 12 岁（32%为女性，46%为持续性 AF）。消融组与药物组相比，新出现认知功能障碍的比例如下：3 个月时：14%比 2%；P = 0.03；6 个月时：4%比 2%；P = NS；12 个月时：0%比 2%；P = NS。消融时间是 POCD 的独立预测因素（P = 0.03）。与药物组相比，消融组有 14%的患者在 12 个月时认知评分显著改善（P = 0.007）。