Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers.

BACKGROUND

Intracardiac echocardiography guidance has emerged as a feasible alternative to transesophageal echocardiography in guiding left atrial appendage occlusion (LAAO). A proposed advantage of this approach is the avoidance of cognitive impairment associated with general anesthesia (GA) in elderly patients.

OBJECTIVES

We studied the effect of anesthesia method (GA vs moderate sedation [MS]) on cognitive function using a novel digital oculomotor biomarker.

METHODS

Patients undergoing LAAO were prospectively enrolled at 2 medical centers (GA center and MS center). Cognitive function was assessed at baseline (V1), 6 hours post-LAAO (V2), and at 45 days (V3) using the ViewMind system, which consists of a head-mounted device with eye-tracking capabilities. We examined differences in cognitive function as measured by 2 oculomotor tests (Go/No Go and N-Back), within each group between V1 vs V2 and V1 vs V3.

RESULTS

Forty patients (20 in each group: GA and MS) were enrolled. Patients in the MS group showed significant long-term (V1 vs V3) improvement in working memory (Δ n complete sequences, P = 0.005), processing speed (Δ n wrong fixations, P = 0.050), and sustained attention (gazing recognition (ms), P = 0.010), as measured by the N-Back task while there were no differences in the GA group (P = 0.180 for Δ n complete sequences, P = 0.410 for Δ n wrong fixations on hitbox, and P = 0.310 gazing recognition [msec]).

CONCLUSIONS

Memory-based oculomotor metrics improved after the procedure in patients undergoing LAAO under MS but not within the GA group. This proof-of-concept study supports a differential impact of sedation strategies on cognitive function in elderly patients undergoing LAAO.