Barra, S; Narayanan, K; Boveda, S; Primo, J; Gonçalves, H; Baran, J; Agarwal, S; ... Providência, R; + view all Barra, S; Narayanan, K; Boveda, S; Primo, J; Gonçalves, H; Baran, J; Agarwal, S; Marijon, E; Providência, R; - view fewer (2019) Atrial Fibrillation Ablation and Reduction of Stroke Events: Understanding the Paradoxical Lack of Evidence. Stroke , 50 (10) pp. 2970-2976. 10.1161/STROKEAHA.119.026890.

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Abstract

Atrial fibrillation (AF) is the most prevalent chronic arrhythmia and a major cause of stroke and mortality. It is thought to confer an overall 5-fold increased risk of a cerebrovascular event, causing ≈one-third of all ischemic strokes. Half of the 2 to 3 fold higher risk of mortality among AF patients is related to AF itself, not only via fatal progression of heart failure, the most frequent mode, but also sudden death and embolic events.1,2 Importantly, AF patients who suffer a cardioembolic stroke have a worse outcome compared with stroke patients without AF. Anticoagulation has been shown to reduce the risk of a cerebrovascular event in AF patients. However, despite adequate anticoagulation, some patients remain at risk of stroke. Whether successful catheter ablation can reduce this risk remains unclear. Although there has not been any convincing evidence thus far that AF ablation leads to a reduction in the risk of stroke, no randomized study was powered to address this question. In this review article, we discuss the AF-stroke association, as well as the apparent lack of evidence supporting the use of ablation for the specific reduction of this end point.

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