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

• Main Authors: Seiji Fukamizu, Rintaro Hojo, Takeshi Kitamura, Iwanari Kawamura, Satoshi Miyazawa, Jun Karashima, Shin Nakamura, Kosuke Takeda, Koichiro Yamaoka, Tomoyuki Arai, Kohei Kawajiri, Sho Tanabe, Yasuki Koyano, Daisuke Miyahara, Sayuri Tokioka, Marina Arai, Dai Inagaki, Tomonori Miyabe, Harumizu Sakurada, Masayasu Hiraoka
• Format: Article
• Language: English
• Published: Wiley 2020-02-01
• Series: Journal of Arrhythmia
• Subjects: atrial fibrillation; catheter ablation; cerebral infarction; pulmonary vein isolation; TOAST classification
• Online Access: https://doi.org/10.1002/joa3.12285

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 appro priate antithrombotic therapy for the prevention of potentially recurrent stroke.