Neurocognition and Greater Maintenance of Sinus Rhythm in AF (NOGGIN AF)

AF 中的神经认知和窦性心律的更好维持 (NOGGIN AF)

• 批准号: 10632044
• 负责人: Joseph P Mathew
• 金额: $ 76.57万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10632044
• 关键词: Ablation; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease risk; Anti-Arrhythmia Agents; Anticoagulation; Arrhythmia; Atrial Fibrillation; Attention Concentration; Automobile Driving; Biological Markers; Blood Platelets; Blood Vessels; Brain; Brain Injuries; Brain region; Cardiac ablation; Cerebral Infarction; Cerebral Ischemia; Cerebrovascular Circulation; Characteristics; Chronic Kidney Failure; Clinical Trials; Coagulation Process; Cognitive; Data; Dementia; Development; Diabetes Mellitus; Disease; Early Intervention; Elderly; Embolism; Endothelium; Enrollment; General Population; Goals; Health; Heart; Heart failure; Hemorrhage; Hypertension; Impaired cognition; Individual; Inflammation; Inflammatory; Link; Maintenance; Maps; Measures; Metabolic; Methods; Myocardial Infarction; National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; Nervous System Trauma; Neurocognition; Neurologic; Neurologic Dysfunctions; Neurological outcome; Oral; Pathologic; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pilot Projects; Plasma; Prevalence; Procedures; Process; Reporting; Research; Risk; Risk Factors; Risk Reduction; Signal Transduction; Sinus; Stroke; Techniques; Testing; Therapeutic Embolization; Thick; Thinness; Thrombin; Tissues; Tube; White Matter Hyperintensity; brain dysfunction; brain health; cerebral atrophy; cerebral hypoperfusion; cerebrovascular; clinical practice; cognitive function; cognitive performance; comorbidity; cost; dementia risk; flexibility; gray matter; heart rhythm; imaging biomarker; improved; insight; ischemic injury; lifetime risk; minimally invasive; mortality; neurocognitive test; neuroimaging; neuroinflammation; older patient; preservation; prevent; prospective; restoration; sound; stroke risk; treatment optimization; vascular cognitive impairment and dementia

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting 1%-3% of the general population, with greater prevalence in older persons (8%-10%). AF is associated with an increased risk for cognitive decline, dementia, stroke, myocardial infarction, heart failure, chronic kidney disease, and mortality, resulting in an incremental yearly cost of AF in the US of $26 billion. AF and cognitive decline share several risk factors including advancing age and comorbidities such as hypertension, diabetes mellitus, and heart failure. Microbleeds from anticoagulation, a proinflammatory and prothrombotic state, and cerebral hypoperfusion can cumulatively result in silent cerebral infarction, white matter hyperintensities, brain atrophy, and disruption of functional network connectivity, and also lead to AF-related cognitive decline. While the link between AF and the development of cognitive impairment has been established, the driving mechanisms and the effect of sinus rhythm restoration are not completely understood. Our long-term goals are to understand the interaction between heart rhythm and neurologic health, and to investigate methods to prevent cognitive dysfunction due to AF. Thus, in the proposed study, we will test our hypothesis that among AF patients receiving oral anticoagulation, restoration of sinus rhythm with catheter ablation vs drug therapy leads to less long-term neurologic damage and dysfunction due to improved cerebral blood flow and lower risk for additional ischemic injury. The primary aims of our prospective, observational clinical trial are to 1) compare structural cortical characteristics in Alzheimer’s disease-risk regions in AF patients treated with catheter ablation vs drug therapy; 2) compare cerebral blood flow in AF patients treated with catheter ablation vs drug therapy; 3) compare cognitive function in AF patients treated with catheter ablation vs drug therapy; and 4) assess the relationship between neurologic outcomes and plasma and imaging biomarkers of coagulation and inflammation. This will be the first study to incorporate a comprehensive neurocognitive test battery, structural and functional neuroimaging, cerebral blood flow assessment, and plasma and imaging biomarkers to a) better delineate the contribution of each of the known risk factors to the development of cognitive decline in patients with AF, and b) assess how restoration of sinus rhythm using catheter ablation vs drug therapy may alter the trajectory of cognitive decline and development of dementia. Our preliminary data showed that catheter ablation did not worsen cognitive function or white matter hyperintensity burden 6 weeks or 1 year later, while drug therapy patients showed greater cortical thinning at 1 year in brain regions associated with Alzheimer’s, and this thinning correlated with worse cognitive performance. Thus, this study is significant, and will vertically advance the field of AF management by revolutionizing our understanding of the mechanisms by which AF induces cognitive decline, and by providing an important and necessary step toward justifying rhythm control by catheter ablation as a strategy to arrest the processes that lead to cognitive impairment and dementia.

心房颤动（AF）是最常见的持续性心律失常，约占总人口的1%-3%

项目成果

Neuromodulation therapy for atrial fibrillation.

• DOI: 10.1016/j.hrthm.2022.08.011
• 发表时间: 2023-01
• 期刊: HEART RHYTHM
• 影响因子: 5.5
• 作者: Karatela, Maham F.;Fudim, Marat;Mathew, Joseph P.;Piccini, Jonathan P.
• 通讯作者: Piccini, Jonathan P.

Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial.

植入式心脏除颤器的警报驱动与预定远程监测：TRUST 试验的成本后果分析。

• DOI: 10.1016/j.hrthm.2022.12.003
• 发表时间: 2023
• 期刊: Heart rhythm
• 影响因子: 5.5
• 作者: Chew,DerekS;Piccini,JonathanP;Au,Flora;Frazier-Mills,CamilleG;Michalski,Justin;Varma,Niraj;TRUSTInvestigators
• 通讯作者: TRUSTInvestigators

Omnipolar Versus Bipolar Electrode Mapping in Patients With Atrial Fibrillation Undergoing Catheter Ablation.

接受导管消融的心房颤动患者的全极与双极电极标测。

• DOI: 10.1016/j.jacep.2022.08.026
• 发表时间: 2022
• 期刊: JACC. Clinical electrophysiology
• 作者: Karatela,MahamF;Dowell,RobertS;Friedman,Daniel;Jackson,KevinP;Piccini,JonathanP
• 通讯作者: Piccini,JonathanP

Rates and predictors of hospital and emergency department care after catheter ablation of atrial fibrillation.

心房颤动导管消融术后医院和急诊科护理的发生率和预测因素。

• DOI: 10.1111/jce.15841
• 发表时间: 2023
• 期刊: Journal of cardiovascular electrophysiology
• 影响因子: 2.7
• 作者: Friedman,DanielJ;Freeman,JamesV;Wong,Charlene;Febre,Janice;Iglesias,Maximiliano;Khanna,Rahul;Piccini,JonathanP
• 通讯作者: Piccini,JonathanP

Device-Related Thrombus After Left Atrial Appendage Occlusion: The Villain of the Piece.

左心耳闭塞后与设备相关的血栓：其中的罪魁祸首。

• DOI: 10.1016/j.jacep.2022.11.029
• 发表时间: 2023
• 期刊: JACC. Clinical electrophysiology
• 作者: Friedman,DanielJ;Piccini,JonathanP
• 通讯作者: Piccini,JonathanP