Risk Factors for Ischemic Stroke in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

Area of Science:

• Cardiology
• Electrophysiology
• Neurology

Background:

• Ischemic stroke following radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients presents a significant clinical challenge.
• Identifying patients at higher risk is crucial for effective stroke prevention strategies.

Purpose of the Study:

• To evaluate clinical and echocardiographic characteristics associated with an increased risk of ischemic stroke post-RFCA in AF patients.
• To compare the predictive performance of a novel REVEEAL score against the established CHA2DS2-VASc score for post-RFCA ischemic stroke.

Main Methods:

• Retrospective analysis of 2,352 consecutive patients with AF undergoing their first RFCA.
• Long-term follow-up (10,023 patient-years) to identify ischemic stroke events.
• Statistical analysis to determine risk factors and compare scoring systems.

Main Results:

• The incidence of ischemic stroke was 0.49% per year.
• Significant risk factors included late recurrence after RFCA, older age (≥60), non-paroxysmal AF, larger left atrium (LA) size (≥45.0 mm), elevated E/E' (≥10), dense spontaneous echo contrast (SEC), and reduced left atrial appendage (LAA) flow velocity (≤40 cm/sec).
• The REVEEAL score demonstrated superior predictive accuracy for ischemic stroke compared to the CHA2DS2-VASc score (p < 0.001).

Conclusions:

• The risk factors for ischemic stroke in AF patients after RFCA differ from those in RFCA-naive patients.
• A distinct approach to risk stratification is necessary for post-RFCA AF patients.
• The REVEEAL score offers improved prediction of ischemic stroke in this population.