Dementia Risk in Afib Patients Treated With Catheter Ablation vs. Antiarrhythmics
The treatment for atrial fibrillation, or Afib, runs on a continuum of care that begins with the least invasive options and typically ends with a minimally invasive cardiac catheter ablation to destroy problematic heart tissue causing the arrhythmia permanently. When we started treating Afib with procedural options, we often prioritized other methods of care simply because, at the time, we did not have the precision and technological advancement that we enjoy today. However, as technology and technique have improved, cardiac catheter ablation has become an ever-more viable early-stage intervention. It can, in qualifying patients, be successful 70 or even 80% of the time.
With that said, whether medication therapy should be started or continued or whether a potentially curative procedural solution should be undertaken is a conversation that each patient will have with their electrophysiologist. However, recent data has given us additional insight into whether antiarrhythmic medication or procedure cardiac catheter ablation is preferable regarding dementia risk in Afib patients.
Before we get deeper into the study, it’s essential to understand dementia risk as it relates to Afib. Not long ago, it was thought that strokes in Afib patients were the primary cause of dementia that sometimes followed. However, as this was studied more carefully, it became apparent that it is not only the stroke that can cause dementia, although cognitive impairment certainly can be an effect of a stroke. Instead, dementia seems to be associated with Afib regardless of whether the patient had a stroke.
With studies like the one we are about to discuss, it is essential to understand all the treatment options, some of which, catheter ablation, for example, may not be fully understood even by some medical professionals. Ultimately, the decision must be made after a comprehensive evaluation from a qualified electrophysiologist. However, the crux of this research shows their patients who were treated with a catheter ablation had a 41% lower risk of dementia versus those who used antiarrhythmic drugs only.1
Our Take
On the surface, this shows that patients, especially those that are good candidates for ablation, might wish to consider a procedural intervention rather than simply staying on an antiarrhythmic. Now, this study does not address stroke risk and medical management using anticoagulant medication. Truthfully, in these cases, the benefits of anticoagulant medication often outweigh the risks and benefits of a procedural left atrial appendage closure like the Watchman or Amulet unless the patient has a bleeding/clotting disorder or is a fall risk. This is, therefore, not a cut-and-dried case of procedural options being better than medication for all things Afib-related. However, based on the study’s results, it is clear that the procedural option to control the arrhythmia is preferable to medication therapy, at least as it relates to dementia.
It’s also important to note that the sponsor of this study is Biosense Webster, a company that sells medical devices and equipment for cardiac catheter ablation procedures. We work with Biosense Webster as well. Despite this, the study seems well-formed.
Ultimately, deciding how to control your AFib is a decision that should be made with the advice of your medical team and mainly your electrophysiologist. Research like this is not meant to sway you one way or the other but educate you and us alike on your condition and treatment options.
Most importantly, it is critical that you treat Afib at its earliest stages so that it does not progress to a more severe stage, which is less reliably treatable. Whether we choose antiarrhythmic medication or a procedural option, our office can speak with you about your specific condition and needs.
Resources:
¹Zeitler EP, Bunch TJ, Khanna R, Fan X, Iglesias M, Russo AM. Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs. Am Heart J. 2022 Dec;254:194-202. doi: 10.1016/j.ahj.2022.09.007. Epub 2022 Sep 20. PMID: 36245141.
