Incidence of Transient Cognitive Decline is High after Ablation for AFib

A study found that short-term postoperative cognitive dysfunction (POCD) is high following catheter ablation to treat atrial fibrillation (AF), but the decline generally improves over time. The results appeared in the BMC Cardiovascular Disorders.

Ablation is the common first-line therapy in the treatment of AF; however, subclinical cerebral ischemia is common during ablation, which may cause postprocedural cognitive decline. Studies on this occurrence are limited, but its known that the incidence of POCD are reported to be as high as 28% two days following AF ablation, though it seems in some part reversible. Researchers of this study sought to discern the association between POCD

This study comprised of 287 patients with normal cognitive functions; including 190 ablated AF patients (study group) and 97 AF patients who are awaiting ablation (practice group). The researchers analyzed the neuropsychological function of each patient twice, 24 hours prior to ablation and 48 hours post-ablation in the study group, and on the day of inclusion and 72 hours later but before ablation in the practice group. They used the reliable change index to assess the neuropsychological testing scores and to identify postoperative cognitive dysfunction (POCD) at 48 hours post-ablation.

POCN Incidence “High in the Short Term”

According to the results, among the ablated AF patients, 13.7% had POCD at 48 hours following ablation procedure. Factors associated with post-procedure POCD were a minimum intraoperative activated clotting time (ACT) < 300 s (OR 3.82, 95% CI, 1.48–9.96, P = 0.006) and not taking oral anticoagulants within one month prior to ablation(OR= 10.35, 95% CI 3.54–30.27, P < 0.001).

However, while global cognitive scores were decreased in 48 hour post-operation tests (0 ± 1 vs − 0.15 ± 1.10, P < 0.001), most cognitive function markedly improved at six months post-operation (0 ± 1 vs 0.43 ± 0.92, P < 0.001).

“Incident of POCD after ablation procedures is high in the short term. Inadequate periprocedural anticoagulation are possible risk factors. However, most POCD are reversible at 6 months, and a general improvement was observed in cognitive function at 6 months after ablation,” the researchers concluded.

 

“Atrial fibrillation ablation is associated with a 13.7% prevalence of POCD within 48 h after ablation procedures. Patients, who were not on routine anticoagulants within one month prior to the ablation procedure and with a minimum intraoperative ACT value of less than 300 s, were found to have a higher association with POCD events. The POCD is temporary in most patients, and a general improvement was observed in cognitive function at 6 months after the procedure. Further studies regarding the long-term effects of catheter ablation on patients’ cognitive function are warranted for a more comprehensive understanding in this area.”