Cognitive function and anticoagulation discontinuation in patients without long-term recurrence after catheter ablation for atrial fibrillation: A substudy of the ALONE-AF trial.

BACKGROUND

In patients without documented recurrence of atrial fibrillation (AF) after ablation, the cognitive impact of oral anticoagulant (OAC) discontinuation remains unclear.

OBJECTIVE

This study aimed to evaluate whether OAC discontinuation is associated with cognitive decline in patients without AF recurrence after catheter ablation.

METHODS

In the ALONE-AF randomized trial, patients with AF aged 19-80 years without atrial arrhythmia recurrence ≥12 months after ablation and with at least 1 non-sex-related stroke risk factor (determined using the CHA2DS2-VASc score), were randomized in a 1:1 ratio to either discontinue or continue OAC therapy. A subset of patients who completed the Montreal Cognitive Assessment (MoCA) at baseline and the 2-year follow-up (318 no-OAC, 328 OAC) was included in the analysis. Changes in the total MoCA score and each cognitive domain were assessed.

RESULTS

The mean age was 63.9 years, 25.9% were women, and the median (interquartile range) CHA2DS2-VASc score was 2 (1-3). At 2-year follow-up, mean total MoCA score increased from 24.4 to 25.0 (difference: 0.6, 95% confidence interval [CI]: 0.3-0.9) in the no-OAC group, and from 24.2 to 24.9 (difference: 0.7, 95% CI: 0.4-1.0) in the OAC group. No difference was observed between no-OAC and OAC groups in total MoCA score change (between-group difference in change: 0.1, 95% CI: -0.3 to 0.5, P = .759), nor in any MoCA domains.

CONCLUSION

Among patients without AF recurrence for at least 12 months after ablation, OAC discontinuation may not be associated with cognitive decline. Findings should be interpreted cautiously, as the study was not designed to evaluate this association.