Ischemic stroke risk during long-term follow up in patients with successful catheter ablation for atrial fibrillation in Korea.

• Main Authors: Dong-Hyeok Kim, Dae-In Lee, Jinhee Ahn, Kwang-No Lee, Seung-Young Roh, Jaemin Shim, Jong-Il Choi, Young-Hoon Kim
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2018-01-01
• Series: PLoS ONE
• Online Access: http://europepmc.org/articles/PMC6053230?pdf=render

The interruption of oral anticoagulation therapy (OAC) after CA of atrial fibrillation (AF) is controversial. The purpose of this study was to evaluate the relationship between successful long-term outcomes of catheter resection and SR maintenance and ischemic stroke risk in Korea. We studied 1,548 consecutive patients who were followed up for more than 2 years after CA of AF. We investigated the incidence of ischemic stroke during long-term follow-up. Compared to the AF recurrence group (n = 619), the sinus rhythm (SR) maintenance group (n = 929) had more paroxysmal AF (74.6% versus 44.4%, p<0.001), smaller LA size (39.9±5.7mm versus 42.3±6.0mm, p<0.001), and younger age (54.2±10.9 years versus 56.4±10.6 years, p<0.001). However, CHA2DS2-VASc scores were not significantly different between the two groups (0.9 vs. 1.1, p = 0.053). The overall incidence of ischemic stroke during the mean follow-up period of 54 months after CA was 0.6%, and was significantly lower in the SR group than the AF recurrence group (0.3% vs. 1.1%, log-rank test p<0.001). However, in sub-analysis in the SR group, the rate of ischemic stroke was significantly increasing in patients with a CHA2DS2-VASc score ≥ 4 compared to those with a CHA2DS2-VASc score < 4 (4.3% vs. 0.2%, log-rank test p<0.001). In conclusion, this long-term follow-up data in patients with AF who underwent successful CA showed that SR maintenance was correlated with a lower rate of ischemic stroke in Korea. However, it was only observed in patients with CHA2DS2-VASc score ≤3.