Reduced dementia risk in patients with optimized anticoagulation therapy undergoing atrial fibrillation ablation

Background Atrial fibrillation (AF) is associated with the development of dementia and observational studies have shown that oral anticoagulation (OAC) and catheter ablation reduce dementia risk. However, such studies did not consistently report on periprocedural anticoagulation and long term OAC coverage, for which reason the separate effect of AF ablation on dementia risk could not be established. Objective We evaluated the protective effect of AF ablation in large cohort who received optimized anticoagulation and compared them with patients who were managed medically. Methods We retrospectively included 5,912 consecutive patients who underwent first-time catheter ablation for AF between 2008 and 2018 and compared them with 52,681 control individuals from the Swedish Patient Register. Propensity score matching produced two cohorts of equal size (n=3,940) with similar baseline characteristics. Dementia diagnosis was identified based on ICD-codes from the patient register. Results The majority of PS-matched patients were on an OAC at the start (94.5%) and end (75.0%) of the study. Mean follow-up was 4.9±2.8 years. Catheter ablation was associated with lower risk for the dementia diagnosis compared with the control group (HR 0.44, 95% CI 0.22-0.86, P=0.017). The result was similar when including patients with a stroke diagnosis prior to inclusion (HR 0.50, 95% CI 0.28-0.89, P=0.019) and after adjusting for the competing risk of death (HR 0.41, 95% CI 0.20-0.86, P=0.018). Conclusions Catheter ablation of AF in patients with optimized OAC therapy was associated with a reduction in dementia diagnosis, even after adjusting for potential confounders and for competing risk of death.