title: Ablation and pacing: improving brain perfusion and cognitive function in patients with atrial fibrillation and uncontrolled ventricular rates.
abstract: BACKGROUND
  The aim of our study was to determine if ablation and pacing improved brain perfusion (BP) and cognitive function (CF) in patients with medically refractory rapidly conducted atrial fibrillation (Med Refr RCAF).
  
  
  RESULTS
  The study included 17 patients with Med Refr RCAF (average age 55.3 ± 4.5 years). All patients underwent brain single photon emission computed tomography scanning with (99m) Tc-hexamethylpropylene amine oxime and comprehensive neuropsychological testing before and after 3 months following pacemaker implantation. The BP was significantly lower in all regions in patients with Med Refr RCAF compared with the control group. The greatest BP decrease was revealed in the inferior frontal (P = 0.002) and posterior parietal (P = 0.024) brain regions. These patients showed cognitive deficit in 94%. There was a direct correlation between BP and CF parameters. Ablation followed by pacemaker implantation had a positive effect on BP and CF in all patients with Med Refr RCAF. Thus, BP increased in the right inferior frontal (P = 0.01), in the left superior frontal (P = 0.007), and in the left temporal (P = 0.005) cortex. These patients demonstrated improvements in immediate and delayed verbal memory, immediate and delayed visual memory, abstract mentation, attention, psychomotor speed, as well as in learning.
  
  
  CONCLUSIONS
  Patients with atrial fibrillation and rapid ventricular rates refractory to medical treatment have marked signs of brain hypoperfusion and impaired CF. Ablation and pacing improve left ventricular systolic function, thereby increasing BP and improving CF.
authors: Department of Nuclear Medicine, Russian Academy of Medical Sciences, Tomsk, Russia. nuclear@cardio.tsu.ru
authors: Irina
authors: I
authors: Efimova
authors: Nataliya
authors: N
authors: Efimova
authors: Vladimir
authors: V
authors: Chernov
authors: Sergey
authors: S
authors: Popov
authors: Yuri
authors: Y
authors: Lishmanov
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery* / Q000628:therapy; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery; D001288:Attention / Q000502:physiology; D001921:Brain / Q000098:blood supply* / Q000502:physiology; D017115:Catheter Ablation; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010138:Pacemaker, Artificial; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime