Letter by Sepehri Shamloo et al Regarding Article, "Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients with Impaired Cognitive Function".

Abstract

October 2019 1 Alireza Sepehri Shamloo, MD Nikolaos Dagres, MD Gerhard Hindricks, MD To the Editor: The term cognitive function in the context of cardiac arrhythmias was first introduced 30 years ago when evidence of cognitive impairment was reported in patients with chronic atrial fibrillation (AF). During the last decades, the topic of cognitive function assessment in AF patients has emerged as a hot topic in the field of electrophysiology; >50 studies have investigated the relationship between these 2 significant public health concerns so far.1 The recently published study conducted by Jin et al2 is groundbreaking and not only confirms findings previously reported by Bunch et al3 about the positive impact of AF ablation on cognitive function but also emphasizes the importance of considering patient-centered outcomes as end points in clinical trials. During the last few decades, hundreds of studies in the field of cardiac arrhythmias have investigated the impact of different therapeutic strategies on major clinical variables including bleeding, stroke, arrhythmia recurrence, and mortality; and a number of them have covered the psychocognitive status as main outcomes. We think that the findings of this current study call to attention the importance of including patient-centered outcomes and also patient-reported outcomes as end points in clinical trials. Currently, management of cognitive dysfunction and controlling the global burden of dementia is one of the top public health priorities designated by the World Health Organization. Moreover, we should not forget that the adherence of treatment and medication intake might be adversely affected by cognitive dysfunction, thereby negatively influencing outcomes and therapy efficiency in the patients suffering from arrhythmias. Although more investigations are required to better define the impact of AF ablation on cognitive status, the recent findings of Jin et al, in conjunction with other studies might be an indication that ablation can improve depression and cognitive function.3–5 This, if supported by further studies, might ultimately lead to the question whether it is time to consider psychocognitive impairments as new indications for AF catheter ablation. Although the current study by Jin et al helps us complete the puzzle of the association between AF, the most common cardiac arrhythmia, and cognitive function, the question which arrhythmia is associated with a greater impairment of cognitive function is still unanswered. Moreover, there is a still a lack of evidence about the impact of different arrhythmia-related procedures, including medical treatment, cardiac device implantation, ablation, or others on patients’ cognitive function. So, when we face this question: Do we need further studies in this field?; the answer is definitely yes. More specifically, the 2 main topics that in our opinion need to be addressed more intensively are (1) the epidemiological understanding of the association between arrhythmias and cognitive function and (2) the impact of arrhythmia-related therapies on cognitive function. LETTER TO THE EDITOR