The Lead Episode 118: A Discussion of Atrial Fibrillation Catheter Ablation, Brain Glymphatic function, and Cognitive performance.

Description

Melissa E. Middeldorp, MPH, PhD, University of Adelaide is joined by Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide and Jared Bunch, MD, FHRS, University of Utah School of Medicine, to discuss a study that investigated the relationship between atrial fibrillation (AF), brain glymphatic function, and cognitive performance. Using MRI-derived diffusion tensor imaging along the perivascular space (DTI-ALPS), the authors found that patients with AF especially those with nonparoxysmal AF exhibited impaired glymphatic activity compared to healthy controls. This reduced glymphatic function was associated with poorer cognitive performance in domains like attention and executive function, and mediation analyses suggested that glymphatic dysfunction partially explains the link between AF and cognitive decline. Notably, in patients who underwent catheter ablation to restore sinus rhythm, glymphatic function significantly improved post-procedure. These findings highlight a novel mechanistic pathway beyond stroke or vascular risk by which AF may contribute to neurodegeneration, and they suggest that rhythm control could offer protective benefits for brain health.

Learning Objectives

To understand the role of the brain's glymphatic system in mediating cognitive decline associated with atrial fibrillation (AF), and how this function can be assessed using diffusion tensor imaging (DTI-ALPS).
To evaluate the potential impact of catheter ablation in improving glymphatic function and cognitive outcomes in patients with AF, highlighting implications for early rhythm control strategies.

Article Authors and Podcast Contributors

Article Authors

Jiahuan Guo , Zhe Zhang , Xu Meng , Jing Jing , Yiran Hu , Yan Yao , Ligang Ding , Lihui Zheng , Xingquan Zhao

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD, University of Adelaide
Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide
Jared Bunch, MD, FHRS, University of Utah School of Medicine

Faculty and Disclosures

All relevant financial relationships have been mitigated.

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

J. Dziano:

Nothing to disclose.

J. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc., Heart Rhythm Society

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.
S. Colbert: No relevant financial relationships with ineligible companies to disclose.

Summary

Availability:

On-Demand

Cost:

FREE

Credit Offered:

No Credit Offered