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

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 followup 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.