Cognitive Function in Patients With Persisted Atrial Fibrillation
Cognitive Function in Patients With Persisted Atrial Fibrillation
Compare the difference of cognitive function between different treatment strategy in patients
 with persistent atrial fibrillation
The prevalence of atrial fibrillation (AF) had been increasing for the past decade. The
 increase of AF was attributed to the aging of the population and the increased awareness of
 the disease among people and the primary physicians. However, we have not achieved the
 consensus whether aggressive rhythm control or conservative rate control is better in a
 patient with asymptomatic persisted AF. We do prescribe anti-coagulant for stroke prevention,
 but which treatment strategy is best for the patients is uncertain.

 The clinical trial of catheter-based ablation for rhythm control compared to traditional
 medication control has not shown the benefit of reducing all-cause mortality, but it did show
 a reduction of re-hospitalization and the recurrence of AF. On the contrary, the study in
 heart failure patients had shown a significant benefit applying catheter-based rhythm control
 strategy to reduce all-cause mortality. The different results of these two trials told us the
 benefit of rhythm control is not easily to be seen in a short-term, but could be seen in a
 long term or in high risk patients. The association between AF and cognitive impairment has
 also been reported in observation cohort. However, there is no sold evidence in clinical
 trials to show the improvement of cognitive function by treating atrial fibrillation. One
 study did show improvement of cognitive function with questionnaire, but the other showed new
 lesion detected by traditional magnetic resonance imaging (MRI) after ablation, though the
 lesion resolved after one year of follow-up. There is no clear answer to which treatment
 strategy is better for the patients' cognitive function。 Therefore, we designe a prospective,
 randomized, blind endpointtrial. We will enroll the patients with persisted AF, and use
 advanced MRI (DTI/SWI) and questionnaire to longitudinally study the cognitive function
 change of the patients before and after the initiation of anti-coagulant agents, before and
 after the catheter-based ablation, and use this as a surrogate to understand the best
 treatment strategy for these AF patients.
Inclusion Criteria:

 1. Those who meet the diagnosis of persistent atrial fibrillation, meet one of the
 following conditions:

 -  The twelve-lead electrocardiogram is used to diagnose atrial fibrillation, and to
 cooperate with clinical diagnosis.

 -  24 hours ECG diagnosis 100% atrial fibrillation, with clinical diagnosis.

 -  The seven-day ECG recorder diagnosed 100% atrial fibrillation.

 2. Willing to accept treatment recommended by doctors, containing anticoagulant, and
 cooperate with examination and treatment in the coming year.

 Exclusion Criteria:

 1. Unwilling to sign the clinical trial consent form.

 2. Unable to complete the cognitive function questionnaire.

 3. Unable to complete brain MRI examination due to various reasons