Background Atrial fibrillation (AF) increases the risk of dementia, and catheter ablation of AF may be associated with a lower risk of dementia. We investigated the association of a rhythm-control strategy for AF with the risk of dementia, compared with a rate-control strategy. Methods This population-based cohort study included 41,135 patients with AF on anticoagulation who were newly treated with rhythm-control (anti-arrhythmic drugs or ablation) or rate-control strategies between 1 January 2005 and 31 December 2015 from the Korean National Health Insurance Service database. The primary outcome was all-cause dementia, which was compared using propensity score overlap weighting. Results In the study population (46.7% female; median age: 68 years), a total of 4,039 patients were diagnosed with dementia during a median follow-up of 51.7 months. Rhythm control, compared with rate control, was associated with decreased dementia risk (weighted incidence rate: 21.2 versus 25.2 per 1,000 person-years; subdistribution hazard ratio [sHR] 0.86, 95% confidence interval [CI] 0.80–0.93). The associations between rhythm control and decreased dementia risk were consistently observed even after censoring for incident stroke (sHR 0.89, 95% CI 0.82–0.97) and were more pronounced in relatively younger patients and those with lower CHA2DS2-VASc scores. Among dementia subtypes, rhythm control was associated with a lower risk of Alzheimer’s disease (sHR 0.86, 95% CI 0.79–0.95). Conclusions Among anticoagulated patients with AF, rhythm control was associated with a lower risk of dementia, compared with rate control. Initiating rhythm control in AF patients with fewer stroke risk factors might help prevent subsequent dementia.

中文翻译：

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心房颤动患者节律控制与痴呆事件的关联：一项基于全国人群的队列研究

背景 心房颤动 (AF) 会增加痴呆的风险，房颤的导管消融可能与痴呆风险的降低有关。我们调查了房颤节律控制策略与痴呆风险之间的关系，并与心率控制策略进行了比较。方法 这项基于人群的队列研究纳入了 41,135 名接受抗凝治疗的 AF 患者，这些患者在 2005 年 1 月 1 日至 2015 年 12 月 31 日期间接受了来自韩国国民健康保险局的节律控制（抗心律失常药物或消融）或心率控制策略的新治疗。数据库。主要结果是全因痴呆，使用倾向评分重叠加权进行比较。结果 在研究人群中（46.7% 为女性；中位年龄：68 岁），在中位随访 51.7 个月期间，共有 4,039 名患者被诊断出患有痴呆症。与心率控制相比，节律控制与痴呆风险降低相关（加权发病率：21.2 对 25.2/1,000 人年；子分布风险比 [sHR] 0.86，95% 置信区间 [CI] 0.80–0.93）。节律控制与痴呆风险降低之间的关联在对卒中事件进行审查后也始终如一地观察到（sHR 0.89, 95% CI 0.82-0.97），并且在相对年轻的患者和 CHA2DS2-VASc 评分较低的患者中更为明显。在痴呆亚型中，节律控制与阿尔茨海默病风险较低相关（sHR 0.86，95% CI 0.79–0.95）。结论 在抗凝治疗的 AF 患者中，与心率控制相比，节律控制与较低的痴呆风险相关。