Does AF ablation improve dementia?

Patients with atrial fibrillation suffer faster cognitive decline than healthy people, in some cases even dementia. However, until recently the reasons have not been understood. We do not have treatments for cognitive decline and dementia caused by Atrial fibrillation but recently researchers have begun to ask whether AF ablation, already proven to help with other symptoms of AF, can also help mental function. For the first time we are beginning to answer the question, “Does AF ablation improve dementia?”.

This month, a group of researchers write in the European Heart Journal that they understand the reason why AF impairs cognitive function. They also have found evidence that AF ablation may reverse the damage.

The researchers found impairment of the brain’s glymphatic system in sufferers of atrial fibrillation. Broadly, the glymphatic is the brain’s “waste system” that helps maintain fluid balance and drain unwanted substances from the brain. It tends to function less well in patients with atrial fibrillation.

The researchers used detailed cognitive tests, and brain imaging with MRI, to examine the glymphatic system. Glymphatic function was worse in sufferers of paroxysmal atrial fibrillation than healthy people. Patients with persistent AF (present all the time) were worse again.

A proportion of patients in the study then underwent AF ablation. Interestingly in this study, markers of glymphatic health improved for patients after an AF ablation procedure.

So, does AF ablation improve dementia?

AF ablation remains one of a range of treatment options for atrial fibrillation. This study is one of a growing number that have demonstrated improved health for patients with AF who undergo ablation. Many researchers are looking into whether AF ablation improves the life chances of people who have the procedure. This remains a controversial area and work is still at an investigative stage.

Nonetheless this study is encouraging for those of us who treat patients with AF. The British Heart Association estimates that half the people with AF in the Uk are unaware of their diagnosis. Findings like this study mean there is even more to gain from heart rhythm treatments, so it’s even more important to get checked for AF.