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Atrial Fibrillation Ablation Patients Have Long-Term Stroke Rates Similar to Patients Without Atrial Fibrillation Regardless of CHADS2 Score
Study Questions:
Does catheter ablation of atrial fibrillation (AF) reduce the risk of stroke?
Methods:
In this retrospective study, three groups of patients were identified from an AF registry and medical record database: 1) 4,212 patients (mean age 65 years) who underwent AF ablation, 2) 16,848 age- and gender-matched patients with AF who did not undergo ablation, and 3) 16,848 age- and gender-matched patients without AF. The primary outcome was stroke rate during a mean follow-up of 2.9 years. Stroke rates were analyzed in relation to CHADS2 score.
Results:
The stroke rate at 1 year was significantly higher in the AF patients who did not undergo ablation (3.5%) than in the AF patients who underwent ablation (1.4%) and the patients without AF (1.4%). The risk of stroke was significantly lower across all age groups and CHADS2 risk scores in the AF patients who underwent ablation than in those who did not. The stroke rates were similar in patients who underwent ablation and the patients with no history of AF across all age groups and CHADS2 risk scores.
Conclusions:
The authors concluded that catheter ablation of AF lowers the risk of stroke.
Perspective:
A major limitation of the study is that there were no data on anticoagulation strategies in the patients with AF or in the post-ablation patients. It is possible that the lower stroke rate in post-ablation patients was attributable to greater use of anticoagulants than in the AF patients who did not undergo ablation. Therefore, the results do not provide any guidance on whether or not patients should be anticoagulated post-ablation. It remains prudent to indefinitely anticoagulate high-risk patients post-ablation.
Keywords: Blood Coagulation, Stroke, Colonic Neoplasms, Cardiology, Databases, Factual, Heart Rate, Catheter Ablation
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