Abstract 12353: Superiority of Atrial Fibrillation Ablation in Reducing Ischemic Stroke, A Comparison Study With AFFIRM Trial
Introduction: The effect of catheter ablation for atrial fibrillation (AF) on the risk of ischemic cerebral event (ICE) is not well defined.
Hypothesis: We hypothesize that catheter ablation is superior to medication in ischemic stroke/TIA reduction.
Methods: We studied AF patients who underwent catheter ablation at the University of Utah between 2007 and 2010 for ICE. We compared the rates of ischemic cerebral event in an ablation group to the rate and rhythm control arms of the AFFIRM trial. Oral anticoagulation (OAC) and ICE were compared between groups.
Results: 388 ablation patients were included and followed for 703±458 days. The mean age was 64±12 years for the ablation group compared to 69±8 in AFFIRM. The CHADS2 score was 1.23±1.09 in the ablation group compared to 1.64±1.25 in AFFIRM. Following ablation, OAC was discontinued in 55% of patients. 7 TIAs occurred, 2 of which were peri-procedural and 5 were 449±334 days post procedure. 3 of the 5 TIAs occurred while the patients were on prescribed OAC. Ischemic strokes occurred in 2 patients, both on OAC therapy. Total ICE rate in catheter ablation group was 1.8%. In AFFIRM, OAC use during follow up was 85% in the rate control arm and 70% in the rhythm control arm. ICE occurred in 77 patients (3.80%) in the rate control arm. OAC was discontinued in 32% of those patients. 80 patients in the rhythm control arm (3.93%) had ICE with OAC discontinued in 57%. AF ablation was associated with an Odds Ratio of 0.45; p=0.03 for ICE compared to rate control and 0.46 compared to anti-arrhythmic drugs (p=0.04) (figure).
Conclusions: In conclusion, catheter ablation of AF is associated with a lower incidence of ICE compared to either a rate or rhythm control strategy using drugs.
- © 2013 by American Heart Association, Inc.