Easing A-Fib With Ablation Therapy Might Also Benefit the Brain
For people with the abnormal heartbeat atrial fibrillation, a procedure called catheter ablation may do more than return the heart to its normal rhythm. It may also ward off mental decline and dementia linked to A-fib, a new study says.
Researchers found that people who receive catheter ablation in addition to medical management for A-fib may be almost 40% less likely to develop cognitive impairment than those treated with drugs alone.
"Atrial fibrillation itself likely leads to changes in cerebral blood flow, which may be detrimental to the overall health of the brain and can lead to adverse outcomes, in this case, cognitive decline," said lead researcher Dr. Bahadar Srichawla, from the neurology department at the University of Massachusetts Chan Medical School.
In A-fib, the heart's upper chambers beat rapidly and irregularly, raising the risk for stroke and possibly dementia. The condition is treated with drugs that return the heart to its normal rhythm or drugs that slow the heart. Another procedure called ablation uses heat applied through a tiny tube to destroy small areas of heart tissue that cause A-fib.
Ablation stops atrial fibrillation and restores the heart's normal rhythm, Srichawla said. "By doing so, the heart is able to effectively pump blood to the brain, thus improving overall brain health. For adults with atrial fibrillation, catheter ablation should be discussed with the primary care physician and/or cardiologist," he said.
For the study, Srichawla and his colleagues studied 887 patients, average age 75. Nearly 200 of them were treated with ablation.
Participants were given memory and thinking tests at the start of the study and again one and two years later. The assessments of short-term memory, attention, concentration and language were scored from zero to 30. Cognitive impairment was defined as a score of 23 or less.
On average, people who had ablation had scores of 25, compared with 23 among people who did not have the procedure, the researchers found.
After accounting for factors like heart disease, kidney disease, sleep apnea and A-fib risk score, those who had catheter ablation were 36% less likely to develop cognitive impairment, Srichawla's team found.
The findings are slated for presentation Monday at the American Academy of Neurology annual meeting, in Boston. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.
Atrial fibrillation may be a marker of a system-wide vascular disorder, which could affect the blood vessels in the brain, said Dr. Laurence Epstein, system director of electrophysiology at Northwell Health in Manhasset, N.Y.
"We also know that people with atrial fibrillation are at higher risk for stroke and not just kind of a massive stroke, but mini-strokes that are subclinical but could lead to cognitive decline and dementia," he said.
Restoring the heart's normal rhythm through ablation may help prevent cognitive decline and stroke, said Epstein, who was not involved with the study.
Moreover, restoring normal rhythm lets patients stop taking medications such as anti-arrhythmic drugs, which can have serious side effects, and beta-blockers, which can make people sluggish, he said.
"The minute you stop the drugs, people tend to feel better," Epstein said.
He noted that an earlier study found that patients who had ablation had better health and survival than patients treated with drugs alone.
"We have growing data now with ablation, showing that if you take even this cognitive or dementia piece out of the picture, that mortality and morbidity is reduced by maintaining normal rhythm," Epstein said.
For more on atrial fibrillation, see the American Heart Association.
SOURCES: Bahadar Srichawla, DO, neurology department, University of Massachusetts Chan Medical School, Worcester; Laurence Epstein, MD, system director, electrophysiology, Northwell Health, Manhasset, N.Y.; presentation, Academy of Neurology, Boston, April 24, 2023