The National Institutes of Health has awarded Duke Anesthesiology chairman, Joseph Mathew, MD, MHSc, MBA, Jerry Reves, MD, Professor of Anesthesiology, a $3,739,083 R01 grant for his project titled, “Neurocognition and Greater Maintenance of Sinus Rhythm in AF (NOGGIN AF).”
Atrial fibrillation (AF), a very common heart rhythm disorder, especially in older adults, increases the risk for a decline in cognitive function and the development of dementia. While the mechanisms by which atrial fibrillation result in brain injury are not well understood, it is also unknown whether restoring regular heart rhythm using a technique called catheter ablation (a minimally invasive procedure in which the doctor advances a flexible thin tube through the blood vessels to the heart to stop abnormal electrical signals in the heart tissue) reduces the likelihood of developing cognitive decline or dementia.
The R01 is a multi-PI grant with Dr. Jonathan Piccini of Duke’s Department of Medicine. In the proposed study, they will determine whether restoring regular heart rhythm using catheter ablation leads to less long-term brain damage and dysfunction than using medications alone. The study is expected to vertically advance the field of AF management by revolutionizing the understanding of the mechanisms by which AF induces cognitive decline, and by providing an important and necessary step toward justifying rhythm control by catheter ablation as a strategy to arrest the processes that lead to cognitive impairment and dementia.
Mathew and Piccini will test the hypothesis that among AF patients receiving oral anticoagulation, restoration of sinus rhythm with catheter ablation vs drug therapy leads to less long-term neurologic damage and dysfunction due to improved cerebral blood flow and lower risk for additional ischemic injury. The primary aims of the prospective, observational clinical trial in AF patients treated with catheter ablation vs drug therapy are to compare structural cortical characteristics, cerebral blood flow, and cognitive function; and assess the relationship between neurologic outcomes and plasma and imaging biomarkers of coagulation and inflammation.
This is the first study to incorporate a comprehensive neurocognitive test battery, structural and functional neuroimaging, cerebral blood flow assessment, and plasma and imaging biomarkers to a) better delineate the contribution of each of the known risk factors to the development of cognitive decline in patients with AF, and b) assess how restoration of sinus rhythm using catheter ablation vs drug therapy may alter the trajectory of cognitive decline and development of dementia.
The long-term goals of this study are to understand the interaction between heart rhythm and neurologic health, and to investigate methods to prevent cognitive dysfunction due to AF.