Risk of Stroke and Atrial Fibrillation After Radiofrequency Catheter Ablation of Typical Atrial Flutter

Nov 15, 2012
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Authors:
Tomson TT, Kapa S, Bala R, et al.
Citation:
Heart Rhythm 2012;9:1779-1784.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the risk of stroke after radiofrequency catheter ablation (RFCA) of atrial flutter (AFl)?

Methods:

This was a retrospective study of 126 patients (mean age 66 years) who underwent successful RFCA of AFl. Warfarin therapy was discontinued 4-6 weeks post-ablation in asymptomatic patients without evidence of AF by monitoring. The occurrence of AF and stroke was analyzed over a mean follow-up of 40 months.

Results:

AF occurred in 37% of patients after RFCA of AFl. Fifty-seven percent of these patients had a history of AF preceding RFCA of AFl. Multivariate analysis revealed no independent predictors of post-ablation AF. Eight of 126 patients (6%) had a stroke post-ablation. The stroke was ischemic in seven patients and hemorrhagic in one. Six of the seven patients (86%) with an ischemic stroke had post-ablation AF. In comparison, only 34% of the 118 patients who were stroke-free had post-ablation AF. Five of the seven patients with a post-ablation stroke were taking warfarin. By multivariate analysis, there were no independent predictors of stroke.

Conclusions:

There is a heightened risk of stroke after successful RFCA of AFl. The only risk factor for post-ablation stroke is post-ablation AF.

Perspective:

The 6% prevalence of stroke among the patients in this study is roughly 4 times higher than the risk of stroke in the general population. The results of the study emphasize the need for serial monitoring for AF in patients who have undergone RFCA of AFl.

Keywords: Stroke, Multivariate Analysis, Warfarin, Catheter Ablation


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