Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers
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 el...
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| Language: | English |
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Elsevier
2025-09-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005150 |
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| author | Agata Sularz, MB, BChir Alejandra Chavez-Ponce, MD Ghasaq Saleh, MD Gurpreet Singh, MD Bilal Unar, MD Trevor Simard, MD Matias Shulz, MScEng Gerardo Fernandez, PhD Danilo Verge, MD, MBA Mohamad Alkhouli, MD, MBA |
| author_facet | Agata Sularz, MB, BChir Alejandra Chavez-Ponce, MD Ghasaq Saleh, MD Gurpreet Singh, MD Bilal Unar, MD Trevor Simard, MD Matias Shulz, MScEng Gerardo Fernandez, PhD Danilo Verge, MD, MBA Mohamad Alkhouli, MD, MBA |
| author_sort | Agata Sularz, MB, BChir |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8e61c13445b2413f881869643eebf8f6 |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-8e61c13445b2413f881869643eebf8f62025-08-24T05:15:34ZengElsevierJACC: Advances2772-963X2025-09-014910209010.1016/j.jacadv.2025.102090Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor BiomarkersAgata Sularz, MB, BChir0Alejandra Chavez-Ponce, MD1Ghasaq Saleh, MD2Gurpreet Singh, MD3Bilal Unar, MD4Trevor Simard, MD5Matias Shulz, MScEng6Gerardo Fernandez, PhD7Danilo Verge, MD, MBA8Mohamad Alkhouli, MD, MBA9Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USADepartment of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USADepartment of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USAViewmind Inc., New York, New York, USAViewmind Inc., New York, New York, USAViewmind Inc., New York, New York, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Address for correspondence: Dr Mohamad Alkhouli, Professor of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.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.http://www.sciencedirect.com/science/article/pii/S2772963X25005150anesthesia, cognitive assessmentleft atrial appendage occlusionpostoperative delirium |
| spellingShingle | Agata Sularz, MB, BChir Alejandra Chavez-Ponce, MD Ghasaq Saleh, MD Gurpreet Singh, MD Bilal Unar, MD Trevor Simard, MD Matias Shulz, MScEng Gerardo Fernandez, PhD Danilo Verge, MD, MBA Mohamad Alkhouli, MD, MBA Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers JACC: Advances anesthesia, cognitive assessment left atrial appendage occlusion postoperative delirium |
| title | Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers |
| title_full | Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers |
| title_fullStr | Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers |
| title_full_unstemmed | Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers |
| title_short | Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers |
| title_sort | prospective evaluation of the impact of sedation during laao on cognitive function using oculomotor biomarkers |
| topic | anesthesia, cognitive assessment left atrial appendage occlusion postoperative delirium |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25005150 |
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