Related Experiment Video
Updated: Nov 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Thromboembolic Risk in Atrial Fibrillation Patients With Left Atrial Scar Post-Extensive Ablation: A Single-Center
Sanghamitra Mohanty1, Chintan Trivedi1, Domenico G Della Rocca1
1Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
Insights
Extensive atrial fibrillation ablation creates more scar tissue but does not increase stroke risk compared to limited ablation. Post-ablation scar, identified by voltage mapping, is not linked to higher thromboembolic events in this study.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Previous studies linked pre-ablation scar to stroke risk in atrial fibrillation (AF) patients.
- Late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR) identified scar before ablation.
- The association between post-ablation scar and stroke risk remained unclear.
Purpose of the Study:
- To evaluate the association between post-ablation scar and stroke risk after atrial fibrillation ablation.
- To compare stroke risk in patients undergoing limited versus extensive ablation procedures.
- To investigate the characteristics of scar tissue formed after different ablation strategies.
Main Methods:
- Retrospective analysis of 6,297 atrial fibrillation patients undergoing initial ablation.
- Patients classified into limited (Group 1) or extensive (Group 2) ablation groups.
- Post-ablation scar assessed using 3D voltage mapping during repeat procedures (n=2,414).
Main Results:
- No significant difference in thromboembolic events between limited (1.02%) and extensive (0.61%) ablation groups (p=0.26).
- Extensive ablation resulted in significantly larger post-ablation scar areas (67.1%) compared to limited ablation (34.9%) (p<0.001).
- All thromboembolic events occurred during active arrhythmia.
Conclusions:
- Post-ablation scar from extensive AF ablation is not associated with an increased stroke risk compared to limited ablation.
- This finding contrasts with previous associations of pre-ablation scar with stroke risk.
- The extent of scar tissue post-ablation may not be a direct predictor of future thromboembolic events.
Objectives:
This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation.
Background:
Late gadolinium enhancement-cardiac magnetic resonance studies have reported a direct association between pre-ablation left atrial scar and thromboembolic events in patients with AF.
Methods:
Consecutive patients with AF were classified into 2 groups based on the type of ablation performed at the first procedure. Group 1 involved limited ablation (isolation of pulmonary veins, left atrial posterior wall, and superior vena cava); and group 2 involved extensive ablation (limited ablation + ablation of nonpulmonary vein triggers from all sites except left atrial appendage). During the repeat procedure, post-ablation scar (region with bipolar voltage amplitude <0.5 mV) was identified by using 3-dimensional voltage mapping.
Results:
A total of 6,297 patients were included: group 1, n = 1,713; group 2, n = 4,584. Group 2 patients were significantly older and had more nonparoxysmal AF. Nineteen (0.3%) thromboembolic events were reported after the first ablation procedure: 9 (1.02%) in group 1 and 10 (0.61%) in group 2 (p = 0.26). At the time of the event, all 19 patients were experiencing arrhythmia. Median time to stroke was 14 (interquartile range: 9 to 20) months in group 1 and 14.5 (interquartile range: 8 to 18) months in group 2. Post-ablation scar data were derived from 2,414 patients undergoing repeat ablation. Mean scar area was detected as 67.1 ± 4.6% in group 2 and 34.9 ± 8.8% in group 1 at the redo procedure (p < 0.001).
Conclusions:
Differently from the cardiac magnetic resonance-detected pre-ablation scar, scar resulting from extensive ablation was not associated with increased risk of stroke compared with that from the limited ablation.
More Related Videos
10:46Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
08:10Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022