Background: Intracardiac echocardiography guidance has emerged as a feasible alternative to transesophageal echocardiography in guiding left atrial appendage occlusion (LAAO). A proposed advantage of this approach is the avoidance of cognitive impairment associated with general anesthesia (GA) in elderly patients.
Objectives: We studied the effect of anesthesia method (GA vs moderate sedation [MS]) on cognitive function using a novel digital oculomotor biomarker.
Methods: Patients undergoing LAAO were prospectively enrolled at 2 medical centers (GA center and MS center). Cognitive function was assessed at baseline (V1), 6 hours post-LAAO (V2), and at 45 days (V3) using the ViewMind system, which consists of a head-mounted device with eye-tracking capabilities. We examined differences in cognitive function as measured by 2 oculomotor tests (Go/No Go and N-Back), within each group between V1 vs V2 and V1 vs V3.
Results: Forty patients (20 in each group: GA and MS) were enrolled. Patients in the MS group showed significant long-term (V1 vs V3) improvement in working memory (Δ n complete sequences, P = 0.005), processing speed (Δ n wrong fixations, P = 0.050), and sustained attention (gazing recognition (ms), P = 0.010), as measured by the N-Back task while there were no differences in the GA group (P = 0.180 for Δ n complete sequences, P = 0.410 for Δ n wrong fixations on hitbox, and P = 0.310 gazing recognition [msec]).
Conclusions: Memory-based oculomotor metrics improved after the procedure in patients undergoing LAAO under MS but not within the GA group. This proof-of-concept study supports a differential impact of sedation strategies on cognitive function in elderly patients undergoing LAAO.
Keywords: anesthesia, cognitive assessment; left atrial appendage occlusion; postoperative delirium.
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