Thu. Jan 17th, 2019

Atrial Fibrillation And Cognitive Impairment

Is Cardiac Ablation the Answer?

(TORONTO, ON) – In 2015, I wrote a series of articles on Atrial Fibrillation, which also included some perspective on Cardiac Ablation, a a procedure used to eliminate Atrial Fibrillation. I did mention that those who are suffering from Atrial Fibrillation are more likely to suffer from cognitive impairment.

However, I don’t think I mentioned that it increases the risk of dementia and Alzheimer’s, which are on the extreme end of cognitive impairment. I think it is necessary to elucidate further.

A recent Swedish study by KIander/Andren/Nyman et al sheds some light on the topic. The study focused on 952 men aged 69-75 over a twenty year period. The stark findings are that men with A-Fib had a lower mean cognitive score than men without A-Fib.

This begs the question of whether the control of A-Fib through drugs or potential elimination of A-Fib through cardiac ablation reduces or eliminates the risk of cognitive impairment.

In these community-living elder men we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

The Swedish study mentioned earlier Rotterdam research concluding that stroke-free women with atrial fibrillation had a higher risk of dementia and cognitive impairment. The Rotterdam study also indicated that atrial fibrillation was linked to Alzheimer’s disease and vascular dementia.

We can conclude that further studies are needed to investigate whether treatment of atrial fibrillation and other risk factors that might prevent or postpone dementia.

A Greek study out of the University of Athens, by Antonis Manolis, backs up the Swedish researchers.

Increasing evidence shows that AF is a risk factor for significant cognitive impairment in patients with and without a manifest stroke via a plethora of pathways further contributing to morbidity and mortality. AF has also been associated with a conversion of cognitive impairment to full dementia.

Manolis indicates that studies have shown those with A-Fib have lower brain volume on an MRI as compared to those without A-Fib. Additionally the more severe and persistent the A-Fib the greater the cognitive decline.

Can then one assume if A-Fib is controlled by anti-arrhythmic drugs, or “eliminated” by a cardiac ablation, cognitive impairment is eliminated or reduced?

However there is increasing evidence that the risk of subtle cognitive decline is more commonplace than the risk of stroke related to the procedure (cardiac ablation). – Knight, EP Lab 2013

Also in 2013, in the Journal of Atrial Fibrillation, Schwarz, Schoenberg et al reported a higher percentage of A-Fib sufferers scored lower in verbal memory when compared to a control group.

In contrast to the control group and in variance of baseline performance the ablation group shared worse neuropsychological outcome in verbal memory tests. Overall 56.5% of the ablation patients deteriorated (at least mildly) from the baseline values in verbal memory as compared to 17.4% of the control group.

So, from what I can determine, it is obvious in medical circles that A-Fib is linked to cognitive impairment. What is still unresolved, however, is whether control of A-Fib through drugs, or its hoped elimination through cardiac ablation, reduces the risk of cognitive impairment.

What is even more unclear is, if a cardiac ablation can somehow reduce or eliminate pre-existing cognitive damages attributed to atrial fibrillation.

Perhaps the answers to these questions can be clarified by a study undertaken by the Texas Cardiac Arrhythmia Research Foundation which will be completed in 2020. The thrust of the study is to explain the Cognitive Impairment on AF Participants After Ablation or on Anti-Arrhythmic Drugs.

In simple terms, if you have A-Fib you are at risk of cognitive impairment, which includes dementia and the dreaded A-word. If you can reduce or eliminate this risk through drugs or a cardiac ablation remains up in the air.

In the meantime as Hui, Morley, Lee et al suggest, in the American Heart Journal in 2015, “… because of the importance of cognitive impairment we recommend that all persons with atrial fibrillation be screened for mild cognitive impairment on an annual basis. Atrial fibrillation confers a 40%-50% higher risk of Alzheimer’s disease and all-cause dementia.”

Of course, please note, that I am not a medical practitioner and I recommend that you discuss cognitive impairment concerning atrial fibrillation with your physician.

My job is done. I am trying to give you a heads up.


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