Recurrent ischemic stroke in patients with atrial fibrillation ablation and prior stroke: A study based on etiological classification

Abstract

Background: Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. This study investigated the incidence and mode of stroke recurrence in patients with a history of stroke who underwent atrial fibrillation (AF) ablation. Methods:Of 825 patients who underwent AF ablation from 2006 to 2016, 77 patients (9.3%, median age 69 years) with a prior ischemic stroke were identified.Patients were classified as those with prior cardioembolic (CE) stroke (n = 55) and those with prior non-CE stroke (n = 22). The incidence and pattern of stroke recurrence were investigated. Results:The incidence of asymptomatic AF (54.5% vs 22.7%; P = .011) and left atrial volume (135.8 mL vs 109.3 mL; P = .024) was greater in the CE group than in the non-CE group. Anticoagulation treatment was discontinued at an average of 28.1 months following the initial ablation in 34 (44.2%) patients. None of the patients developed CE stroke during a median 4.1-year follow-up. In the non-CE group, 2 patients experienced recurrent non-CE stroke (lacunar infarction in 1 and atherosclerotic stroke in 1); however, AF was not observed at the onset of recurrent ischemic stroke. Conclusions:In patients with a history of stroke who underwent catheter ablation for AF, the incidence of recurrent stroke was 0.54/100 patient-years. The previous stroke in these patients may not have been due to AF in some cases; therefore, a large-scale prospective study is warranted to identify the appropriate antithrombotic therapy for the prevention of potentially recurrent stroke.

A novel scoring system for stroke risk stratification in Japanese patients with low CHADS2 scores: Study using a transesophageal‐echocardiogram endpoint

“…24 Optimal anticoagulation management to minimize periprocedural complications in patients undergoing catheter ablation has not been established. [24][25][26] Hence, we attempted to improve thrombotic risk stratification in patients scheduled for AF ablation by data including TEE and CT. Detailed stratification of AF risk is important before catheter ablation, but it may also be useful for determining the timing of discontinuation of anticoagulation therapy after catheter ablation.…”