Dementia: How catheter ablation can reduce risk in people with A-fib

• Atrial fibrillation affects about 30 million people worldwide.
• Researchers report that people who have had cardiac ablation for the condition are less likely to develop dementia than those who did not have it.
• They also noted that there was a significantly reduced all-cause death rate for people who had cardiac ablation.

A study published today in the Journal of the American Geriatrics Society is reporting that catheter ablation is linked to a lower risk of dementia and premature death in people with atrial fibrillation (A-fib).

For their study, the researchers searched TriNetX, a global federated health research network, for people who were older than 65 and received a diagnosis of A-fib at least five years before September 28, 2022.

The scientist created two groups, one with participants who had cardiac ablation and another from people who did not have catheter ablation.

The researchers balanced each group for age, gender, ethnicity, co-morbidities, and cardiovascular medications. Both groups had about 20,700 participants.

After comparing the two groups, the scientists reported that the group who did not receive ablation had 439 cases of dementia. The group that received the procedure had 253 cases.

They also found that there was a significantly reduced all-cause death rate between the two groups. The ablation group had 2,447 deaths compared to 3,509 deaths in the non-ablation group.

Reaction to the A-fib treatment and dementia risk study

“These are interesting and exciting conclusions — that ablation can reduce mortality and dementia,” said Dr. Stephen Tang, a cardiac electrophysiologist at Providence Saint John’s Health Center in California who was not involved in the study.”

“Certainly, it would be exciting for our field. Aside from a few special populations, such as heart failure patients, prospective clinical trials using rhythm control have not been able to prove this type of benefit from ablation,” Tang told Medical News Today.

The researchers reported that the differences were consistent across subgroups that included age, gender, atrial fibrillation subtype, and comorbidity.

“This is a perspective study,” said Dr. Joel Salinas, a behavioral neurologist and researcher at NYU Langone Health and the chief medical officer at Isaac Health in New York who was not involved in the study.

“[That means] the researchers looked back on what happened rather than being involved in the process,” Salinas explained to Medical News Today. “One limitation of this study is we don’t know the results of the ablation. Was it successful? It would be useful to know whether dementia rates were lower in those with successful ablation compared to those that were unsuccessful.”

“The connection between ablation and dementia is probably not between the procedure and dementia,” he added. “Instead, it is most likely between the reduced risk of stroke and blood clots in the brain from the ablation and dementia.”

What to know about atrial fibrillation

Atrial fibrillation is an arrhythmia or irregular heart rate. This can cause your heart to not pump blood efficiently.

A-fib affects an estimated 30 million people worldwide. It is a major cause of stroke, heart failure, hospitalizations, and deaths.

Treating A-fib might start with lifestyle changes, such as diet, exercise, stress management, limited alcohol intake, and quitting smoking.

Some medications could help that might help include:

• Beta-blockers
• Blood thinners
• Calcium channel blockers

If these treatments don’t work, your doctor may want you to consider cardiac ablation.

“Numerous trials have shown better efficacy of rhythm control with ablation versus medication, Tang said. “Less atrial fibrillation means fewer opportunities for any of the above processes to occur.”

What is cardiac ablation?

Cardiac ablation uses either radiofrequency energy (heat) or cryoablation (cold) to destroy a small area of heart tissue that is causing rapid or irregular heartbeat, according to the American Heart Association.

Destroying the tissue helps to restore your heart’s regular rhythm. The procedure does not destroy any of the surrounding tissue.

The procedure usually occurs as an outpatient procedure. You are given a sedative before the surgery to help you relax, according to the National Library of Medicine.

The physician will make a small incision in the groin or arm to access a blood vessel that the catheter is fed through to your heart with the help of live X-rays. Once the catheter is in place, the cardiologist places small electrodes on your heart. This helps them to locate the area of your heart where the problem is located. Based on the procedure you are getting, electrical or cold energy will be sent to the site, creating a scar.

The procedure usually takes 3 to 6 hours.

According to Kaiser Permanente, your doctor will consider several factors when recommending cardiac ablation. These include:

• If you have paroxysmal atrial fibrillation
• The severity of your symptoms
• If you have heart failure
• What treatment you have already tried

Some risks can accompany cardiac ablation, including:

• Problems during the treatment procedure are rare but include bleeding, an accidental hole in the heart, and nerve damage in the chest.
• Problems after the procedure can include mild pain, bleeding, and bruising.

After talking with your doctor, you may decide on cardiac ablation if:

• Your symptoms interfere with your daily life.
• You do not want or cannot tolerate medication because of side effects or other health conditions.
• You have tried medications, but they are not working.

According to a report published in 2022, the success rate for a first cardiac ablation was 78% and for people who had a second ablation, the success rate was 64%. After 2 years, regardless of the number of ablations, the probability to be in sinus rhythm was 78%.

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