Is Catheter Ablation Associated with Preservation of Cognitive Function? An Analysis From the SAGE-AF Observational Cohort Study.
Is Catheter Ablation Associated with Preservation of Cognitive Function? An Analysis From the SAGE-AF Observational Cohort Study.
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导管消融与认知功能的保留有关吗？
DOI：
10.1101/2023.11.20.23298768
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Moonis,Majaz
中科院分区：
文献类型：
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作者：
Srichawla,BahadarS;Hamel,AlexanderP;Cook,Philip;Aleyadeh,Rozaleen;Lessard,Darleen;Otabil,EdithM;Mehawej,Jordy;Saczynski,JaneS;McManus,DavidD;Moonis,Majaz
ObjectivesTo examine catheter ablation treatment（CA）vs. medical management and cognitive impairment among older adults with atrial fibrillation（AF）.MethodsAmbulatory patients who have AF，are ≥65-years old，并且有资格接受口服抗凝治疗的患者可以入组SAGE（老年要素的系统评估）-2016年至2018年期间来自马萨诸塞州和格鲁吉亚内科和心脏病诊所的AF研究。在基线、1年和2年时使用蒙特利尔认知评估（莫卡）工具评估认知功能。认知损害定义为莫卡评分≤ 23。采用纵向重复测量的多因素调整logistic回归分析，研究CA治疗与药物治疗和认知功能障碍之间的关系。平均而言，参与者年龄为75.2 ± 6.7岁，48.6%为女性，87.4%为白色非西班牙裔。193例（21.8%）受试者在入组前接受了CA。在2年研究期间，既往接受过CA的参与者发生认知损害的可能性（aOR 0.70，95% CI 0.50-0.97）显著低于药物治疗的参与者（即，频率和/或节律控制），即使在用CA的倾向评分调整后。在2年的随访中，非CA组中认知功能受损的个体数量显著增加（莫卡≤ 23）与CA组相比（311 [44.8%] vs. 58 [30.1%]，p = 0.0002）。结论在此2-在入组前接受CA治疗AF的1年纵向前瞻性队列研究参与者比那些没有经历过CA。
ObjectivesTo examine the associations between catheter ablation treatment (CA) vs. medical management and cognitive impairment among older adults with atrial fibrillation (AF).MethodsAmbulatory patients who had AF, were ≥65-years-old, and were eligible to receive oral anticoagulation could be enrolled into the SAGE (Systematic Assessment of Geriatric Elements)-AF study from internal medicine and cardiology clinics in Massachusetts and Georgia between 2016 and 2018. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool at baseline, 1-, and 2 years. Cognitive impairment was defined as a MoCA score ≤ 23. Multivariate-adjusted logistic regression of longitudinal repeated measures was used to examine associations between treatment with CA vs. medical management and cognitive impairment.Results887 participants were included in this analysis. On average, participants were 75.2 ± 6.7 years old, 48.6% women, and 87.4% white non-Hispanic. 193 (21.8%) participants received a CA before enrollment. Participants who had previously undergone CA were significantly less likely to be cognitively impaired during the 2-year study period (aOR 0.70, 95% CI 0.50–0.97) than those medically managed (i.e., rate and/or rhythm control), even after adjusting with propensity score for CA. At the 2-year follow-up a significantly greater number of individuals in the non-CA group were cognitively impaired (MoCA ≤ 23) compared to the CA-group (311 [44.8%] vs. 58 [30.1%],p = 0.0002).ConclusionIn this 2-year longitudinal prospective cohort study participants who underwent CA for AF before enrollment were less likely to have cognitive impairment than those who had not undergoneCA.