To conduct an umbrella review of systematic reviews/Meta-analyses evaluating the impact of atrial fibrillation (AF) treatment strategies on cognitive function in AF patients, thereby providing evidence-based insights for clinical practice. 

PubMed, Web of Science, Ovid, SinoMed, CNKI, Wanfang, and VIP databases (from inception to March 22, 2025) were systematically searched to identify systematic reviews/Meta-analyses assessing the effects of AF treatment strategies on cognitive function. Two researchers independently screened studies, extracted data, and evaluated methodological quality, risk of bias, reporting compliance, and evidence certainty using AMSTAR 2, ROBIS, PRISMA, and GRADE tools.

A total of 24 studies were included. Methodological quality was rated as high in 7 studies (29.17%), moderate in 6 (25.00%), low in 7 (29.17%), and critically low in 4 (16.67%). Risk of bias was low in 4 studies (16.67%) and high in 20 (83.33%). Reporting quality was high in 4 studies (16.67%), moderate in 18 (75.00%), and low in 2 (8.33%). Evidence certainty was moderate for 11 outcomes (21.15%), low for 23 (44.23%), and very low for 18 (34.62%). Results indicated that anticoagulation therapy (particularly direct oral anticoagulants) and catheter ablation might reduce the risk of cognitive impairment in AF patients, but conclusions on dementia subtypes (e.g., Alzheimer's disease, vascular dementia) remained inconsistent. 

AF treatment may delay cognitive decline; however, the overall quality of existing systematic reviews is limited. High-quality studies are urgently needed to validate therapeutic efficacy and explore underlying mechanisms.