Srichawla Bahadar S, Hamel Alexander P, Cook Philip, Aleyadeh Rozaleen, Lessard Darleen, Otabil Edith M, Mehawej Jordy, Saczynski Jane S, McManus David D, Moonis Majaz
Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Front Neurol. 2024 Jan 5;14:1302020. doi: 10.3389/fneur.2023.1302020. eCollection 2023.
To examine the associations between catheter ablation treatment (CA) vs. medical management and cognitive impairment among older adults with atrial fibrillation (AF).
Ambulatory patients who had AF, were ≥65-years-old, and were eligible to receive oral anticoagulation could be enrolled into the SAGE (Systematic Assessment of Geriatric Elements)-AF study from internal medicine and cardiology clinics in Massachusetts and Georgia between 2016 and 2018. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool at baseline, 1-, and 2 years. Cognitive impairment was defined as a MoCA score ≤ 23. Multivariate-adjusted logistic regression of longitudinal repeated measures was used to examine associations between treatment with CA vs. medical management and cognitive impairment.
887 participants were included in this analysis. On average, participants were 75.2 ± 6.7 years old, 48.6% women, and 87.4% white non-Hispanic. 193 (21.8%) participants received a CA before enrollment. Participants who had previously undergone CA were significantly less likely to be cognitively impaired during the 2-year study period () than those medically managed (i.e., rate and/or rhythm control), even after adjusting with propensity score for CA. At the 2-year follow-up a significantly greater number of individuals in the non-CA group were cognitively impaired (MoCA ≤ 23) compared to the CA-group (311 [44.8%] vs. 58 [30.1%], ).
In this 2-year longitudinal prospective cohort study participants who underwent CA for AF before enrollment were less likely to have cognitive impairment than those who had not undergone
探讨导管消融治疗（CA）与药物治疗对老年房颤（AF）患者认知功能障碍的影响。
2016年至2018年期间，年龄≥65岁、符合口服抗凝治疗条件且患有房颤的门诊患者可从马萨诸塞州和佐治亚州的内科和心脏病诊所纳入SAGE（老年因素系统评估）-AF研究。在基线、1年和2年时使用蒙特利尔认知评估（MoCA）工具评估认知功能。认知障碍定义为MoCA评分≤23。采用纵向重复测量的多变量调整逻辑回归分析，探讨CA治疗与药物治疗和认知障碍之间的关系。
本分析纳入了887名参与者。参与者平均年龄为75.2±6.7岁，48.6%为女性，87.4%为非西班牙裔白人。193名（21.8%）参与者在入组前接受了CA治疗。即使在根据CA倾向评分进行调整后，先前接受过CA治疗的参与者在2年研究期间认知功能障碍的可能性也显著低于接受药物治疗（即心率和/或节律控制）的参与者。在2年随访时，与CA组相比，非CA组中认知功能障碍（MoCA≤23）的个体数量显著更多（311例[44.8%] vs. 58例[30.1%]）。
在这项为期2年的纵向前瞻性队列研究中，入组前接受AF-CA治疗的参与者比未接受治疗的参与者发生认知功能障碍的可能性更低。
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