PVI and Neurocognitive Dysfunction in Atrial Fibrillation

Citing the association between atrial fibrillation and cognitive dysfunction, researchers sought to compare neurocognitive outcomes in patients with atrial fibrillation who did or did not undergo pulmonary vein isolation (PVI). In the study, published in Frontiers of Cardiovascular Medicine, lead author Leon Zwimpfer reported that there was no consistent evidence of a link between PVI for atrial fibrillation and neurocognitive function.

The study enrolled 1576 patients from the Swiss Atrial Fibrillation Cohort with documented atrial fibrillation and no previous PVI. Participants who underwent PVI with 1 year of follow-up on PVI status and neurocognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), trail making test A and B, digit symbol substitution test, and semantic fluency test. The investigators used propensity score matching and inverse probability of treatment weighting to assess potential associations between PVI and neurocognitive functioning.

PVI Showed No Impact on Neurocognitive Dysfunction in Atrial Fibrillation

The cohort had a mean age of 74 ± 8 years and was 27.1% female. Of the full cohort, 88 patients (5.5%) underwent PVI during the 1-year follow-up. Based on inverse probability of treatment weighting on all patients, PVI showed a weak association with MoCA score after adjusting for covariates (β, 1.19; 95 CI, 0.05-2.32; P=.04).

However, in p;ronesity-matched comparison involving 352 patients, there was no significant association observed between PVI and MoCA score (β, 1.04; 95% CI, -0.19 to 2.28; P=.1). In addition, the authors reported there were no associations identified between PVI and the other neurocognitive function assessment tools.

In short, the authors stated that “Pulmonary vein isolation showed no strong positive or negative effects on most cognitive tests after a follow-up of 1 year. Whether rhythm control using PVI has a long-term effect on neurocognitive function is currently unknown and needs to be investigated in future studies.”

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