title: Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation.
abstract: OBJECTIVE
  This study sought to determine whether post-operative neurocognitive dysfunction (POCD) occurs after ablation for atrial fibrillation (AF).
  
  
  BACKGROUND
  Ablation for AF is a highly effective strategy; however, the risk of transient ischemic attack and stroke is approximately 0.5% to 1%. In addition, magnetic resonance imaging studies report a 7% to 14% prevalence of silent cerebral infarction. Whether cerebral ischemia results in POCD after ablation for AF is not well established.
  
  
  METHODS
  The study included 150 patients; 60 patients undergoing ablation for paroxysmal atrial fibrillation (PAF), 30 patients undergoing ablation for persistent atrial fibrillation (PeAF), and 30 patients undergoing ablation for supraventricular tachycardia (SVT) were compared with a matched nonoperative control group of patients with AF awaiting radiofrequency ablation (n = 30). Eight neuropsychological tests were administered at baseline and at 2 days and 90 days post-operatively. The tests were administered at the same time points to the nonoperative control group. The reliable change index was used to calculate POCD.
  
  
  RESULTS
  The prevalences of POCD at day 2 post-procedure were 28% in patients with PAF, 27% in patients with PeAF, 13% in patients with SVT, and 0% in control patients with AF (p = 0.007). At day 90, the prevalences of POCD were 13% in patients with PAF, 20% in patients with PeAF, 3% in patients with SVT, and 0% in control patients with AF (p = 0.03). When analyzing the 3 procedural groups together, 29 of 120 patients (24%) manifested POCD at day 2 and 15 of 120 patients (13%) at day 90 post-procedure (p = 0.029). On univariate analysis, increasing left atrial access time was associated with POCD at day 2 (p = 0.04) and day 90 (p = 0.03).
  
  
  CONCLUSIONS
  Ablation for AF is associated with a 13% to 20% prevalence of POCD in patients with AF at long-term follow-up. These results were seen in a patient population with predominant CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) scores of 0 to 1, representing the majority of patients undergoing ablation for AF. The long-term implications of these subtle changes require further study.
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Medi
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Evered
authors.forename: Brendan
authors.initials: B
authors.lastname: Silbert
authors.forename: Andrew
authors.initials: A
authors.lastname: Teh
authors.forename: Karen
authors.initials: K
authors.lastname: Halloran
authors.forename: Joseph
authors.initials: J
authors.lastname: Morton
authors.forename: Peter
authors.initials: P
authors.lastname: Kistler
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kalman
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000145:classification / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D015995:Prevalence; D013617:Tachycardia, Supraventricular / Q000601:surgery
keywords: ACT; AF; CERAD; CHADS(2); CI; Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack; Consortium to Establish a Registry for Alzheimer's Disease; IQ; MRI; OR; PAF; POCD; PeAF; RCI; RFA; SVT; ablation; activated clotting time; atrial fibrillation; confidence interval; intelligence quotient; magnetic resonance imaging; neurocognitive dysfunction; odds ratio; outcomes; paroxysmal atrial fibrillation; persistent atrial fibrillation; post-operative cognitive dysfunction; radiofrequency ablation; reliable change index; supraventricular tachycardia