Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients

Background Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but its impact on long-term stroke risk is unknown. Objective We sought to evaluate the periprocedural and long-term stroke risk after catheter ablation or cardioversion for AF. Methods This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA₂DS₂-Vasc score, and Charlson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups. Results A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periprocedural stroke or TIA occurred in 0.5% of the ablation group and 0.3% of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03). Conclusion In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.