Table 3.
Studies assessing the effects of rhythm control on cognitive decline in atrial fibrillation
| Effects of rhythm control on AF-related cognitive impairment and dementia | |||
|---|---|---|---|
| Study | Participants | Study type | Summary of findings |
| AFFIRM52 | 4060 | Interventional RCT | Cognitive performance was similar at all timepoints between rhythm and rate control groups. |
| Bunch et al. (2011)41 | 37 908 | Retrospective observational | Patients treated with AF catheter ablation had similar rates of dementia to a control group without AF, and significantly lower rates than AF patients who did not undergo ablation. |
| Damanti et al. (2018)42 | 1082 | Retrospective observational | Cognitive performance was highest in those who underwent rhythm control for AF compared with rate control or no therapy (rhythm control adjusted OR 0.56 95% CI 0.40–0.79; P = −0.001). |
| Jin et al. (2019)45 | 308 | Prospective observational | After 12 month follow-up, MoCA score significantly improved in the ablation cohort, even after propensity score matching, but not in the unablated cohort. |
| Tischer et al. (2019)50 | 90 | Prospective observational | No difference in prevalence or progression of cognitive impairment was detected between ablation and medically treated groups. |
| Hsieh et al. (2020)44 | 2344 | Retrospective observational | Over mean 9 year follow-up, the incidence of dementia was lower in the AF group who received catheter ablation compared with AF without ablation (aHR 0.44; P = 0.005). |
| Kim et al. (2020)46 | 194 928 | Retrospective observational | Over median 52 month follow-up, ablation for AF was associated with reduced risk of dementia compared with medical therapy (HR 0.73, 95% CI 0.58–0.93). |
| EAST-AFNET 4 (2020)40 | 2789 | Interventional RCT | Early rhythm control (mostly with antiarrhythmic drugs) was not associated with significant cognitive change after median 5 years of follow-up (MoCA score treatment effect −0.14 (95% CI −0.39 to +0.12). |
| Wang et al. (2021)51 | 139 | Prospective observational | Cognitive scores were significantly improved in the catheter ablation group (with no difference by ablation modality) compared with medically treated patients. |
| Kim et al. (2022)54 | 41 135 | Retrospective observational | Rhythm control was associated with significantly reduced risk of dementia (sHR 0.89, 95% CI 0.82–0.97). |
| Bodagh et al. (2022)55 | 15 886 | Meta-analysis | Catheter ablation was associated with a significantly lower risk of dementia compared with medical therapy (HR 0.60, 95% CI 0.42–0.88; P < 0.05). |
AF, atrial fibrillation; aHR, adjusted hazard ratio; MoCA, Montreal Cognitive Assessment; RCT, randomised controlled trial; and sHR, subdistribution hazard ratio.