Impact of oral anticoagulation therapy versus left atrial appendage occlusion on cognitive function and quality of life in patients with atrial fibrillation

Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Joanna Assadourian, Angel Quintero Mayedo, Bryan Macdonald, Domenico G. Della Rocca, Carola Gianni, Rodney Horton, Amin Al-Ahmad, Mohamed Bassiouny, John D. Burkhardt, Luigi Di Biase, M. Edip Gurol, Andrea Natale

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation. METHODS AND RESULTS: Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow-up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHA2 DS2-VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHA2 DS2-VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (P=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated −2.74 (95% CI, −3.61 to −1.87; P<0.0001) points in the OAC group, whereas the change in the LAAO group was nonsignificant (0.79; (95% CI, −0.06 to 1.64; P=0.07). After adjusting for baseline clinical characteristics, remaining on OAC was an independent predictor of MoCA change at 1 year (regression coefficient, −3.38; 95% CI, −4.75 to −2.02; P<0.0001). Change in Atrial Fibrillation Effect on Quality of Life score did not differ significantly in achieving a clinically important difference between groups. CONCLUSIONS: In this series, a significant difference in the postprocedure MoCA score was observed in postablation patients with atrial fibrillation receiving LAAO versus remaining on OAC with a substantial decline in the score in the OAC group. However, quality of life improved similarly across groups.

Original languageEnglish (US)
Article numbere019664
JournalJournal of the American Heart Association
Volume10
Issue number9
DOIs
StatePublished - 2021

Keywords

  • AFEQT
  • Atrial fibrillation (AF)
  • Cognition
  • Left atrial appendage occlusion (LAAO)
  • MoCA
  • Oral anticoagulation (OAC)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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