Ablation and Pacing: Improving Brain Perfusion and Cognitive Function in Patients with Atrial Fibrillation and Uncontrolled Ventricular Rates
Version of Record online: 29 NOV 2011
©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 35, Issue 3, pages 320–326, March 2012
How to Cite
EFIMOVA, I., EFIMOVA, N., CHERNOV, V., POPOV, S. and LISHMANOV, Y. (2012), Ablation and Pacing: Improving Brain Perfusion and Cognitive Function in Patients with Atrial Fibrillation and Uncontrolled Ventricular Rates. Pacing and Clinical Electrophysiology, 35: 320–326. doi: 10.1111/j.1540-8159.2011.03277.x
- Issue online: 5 MAR 2012
- Version of Record online: 29 NOV 2011
- Received January 18, 2011; revised September 12, 2011; accepted September 13, 2011.
- atrial fibrillation;
- single photon emission computed tomography;
- brain perfusion;
- cognitive function;
- pacemaker implantation
Background: The aim of our study was to determine if ablation and pacing improved brain perfusion (BP) and cognitive function (CF) in patients with medically refractory rapidly conducted atrial fibrillation (Med Refr RCAF).
Methods and Results: The study included 17 patients with Med Refr RCAF (average age 55.3 ± 4.5 years). All patients underwent brain single photon emission computed tomography scanning with 99mTc-hexamethylpropylene amine oxime and comprehensive neuropsychological testing before and after 3 months following pacemaker implantation. The BP was significantly lower in all regions in patients with Med Refr RCAF compared with the control group. The greatest BP decrease was revealed in the inferior frontal (P = 0.002) and posterior parietal (P = 0.024) brain regions. These patients showed cognitive deficit in 94%. There was a direct correlation between BP and CF parameters. Ablation followed by pacemaker implantation had a positive effect on BP and CF in all patients with Med Refr RCAF. Thus, BP increased in the right inferior frontal (P = 0.01), in the left superior frontal (P = 0.007), and in the left temporal (P = 0.005) cortex. These patients demonstrated improvements in immediate and delayed verbal memory, immediate and delayed visual memory, abstract mentation, attention, psychomotor speed, as well as in learning.
Conclusions: Patients with atrial fibrillation and rapid ventricular rates refractory to medical treatment have marked signs of brain hypoperfusion and impaired CF. Ablation and pacing improve left ventricular systolic function, thereby increasing BP and improving CF. (PACE 2011;1–7)