This prospective randomised study investigates the impact of catheter ablation versus medical therapy on neurocognitive function (NCF) in patients aged 65 years and older with persistent atrial fibrillation (AF). The hypothesis suggests that eliminating persistent AF with catheter ablation in this demographic will lead to enhanced NCF compared to patients undergoing medical therapy alone. Background research indicates that patients with AF experience a faster decline in NCF compared to age-matched counterparts, with an increased risk of dementia, irrespective of major embolic stroke occurrences. This decline is particularly pronounced in individuals over 65 years old, attributed to factors including recurrent micro-emboli and impaired haemodynamic control resulting in periodic cerebral hypo-perfusion. Observational studies suggest a lower risk of neurocognitive decline and dementia in patients undergoing catheter ablation compared to those treated medically. However, such studies are susceptible to selection bias favouring patients with fewer comorbidities and less advanced cardiovascular disease for ablation. In previous randomised trial data with a 12- month follow-up, an initial decline in NCF following AF ablation was observed in a subset of patients, resolving within six months and showing improvement at twelve months compared to medical therapy. In this randomised trial, we aim to prospectively evaluate whether AF ablation yields long-term benefits, including improvement and prevention of further decline, in NCF compared to medical therapy, specifically in an at-risk population aged 65 years and older with persistent AF. Follow-up assessments will be conducted over 24 months to track the trajectory of NCF outcomes.
Last updated31 October 2025