Background: Inadequate management of atrial fibrillation (AF) after stroke is associated with worse prognosis, and the impact of early rhythm control with catheter ablation (CA) on neurological outcomes in these patients is poorly understood.
Objectives: This study sought to evaluate the impact of early rhythm control with CA in patients with new-onset AF at the time of stroke.
Methods: We performed a retrospective, observational study of patients hospitalized with stroke and new-onset AF from 2021 to 2023. Patients underwent routine care (n=36) with rate control or anti-arrhythmic drugs or rhythm control with CA (n=36) after discharge. Functional neurological outcomes at admission, discharge, 6- and 12-months were measured using the modified Rankin score (mRS) - a scoring system from 0-6, describing patient activity levels. AF-related outcomes are also measured.
Results: Though mRS was similar at admission (4.5±1.0 vs. 4.4±1.0; p=0.717) and discharge (4.23±0.7 vs. 4.2±0.8; p=0.656), it was lower at 6- (2.0±0.7 vs. 3.5±0.8; p<0.001) and 12- (1.1±0.8 vs. 3.0±1.0; p<0.001) months for those that underwent CA. They also had a faster time to rhythm control (54.5±15.6 vs. 73.1±26.3; p<0.001) and continued AF freedom at 12 months (100% vs. 13.9%, p<0.001), with fewer repeat strokes (0% vs. 13.9%, p=0.091), major bleeding (11.1% vs 25%, p=0.126), number of hospitalizations (0.4±0.8 vs 1.8±1.5, p<0.001), and mortality (0% vs 11.1%, p<0.001).
Conclusions: Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in study populations, it is uncertain if these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Kelvin N.V. Bush, MD, FACC
Important Dates
Date of Release: May 26, 2025
Term of Approval/Date of CME/MOC Expiration: May 25, 2026