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

• Published in: PloS one Vol. 13; no. 7; p. e0201061
• Main Authors: Kim, Dong-Hyeok, Lee, Dae-In, Ahn, Jinhee, Lee, Kwang-No, Roh, Seung-Young, Shim, Jaemin, Choi, Jong-Il, Kim, Young-Hoon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.07.2018; Public Library of Science (PLoS)
• Subjects: Analysis; Anticoagulants; Atrial fibrillation; Atrial Fibrillation - surgery; Biology and Life Sciences; Brain Ischemia - epidemiology; Brain Ischemia - etiology; Cardiac arrhythmia; Cardiology; Care and treatment; Catheter ablation; Catheter Ablation - adverse effects; Catheters; Complications and side effects; Drug therapy; Female; Fibrillation; Follow-Up Studies; Health risks; Humans; Incidence; Internal medicine; Ischemia; Maintenance; Male; Medical instruments; Medicine; Medicine and Health Sciences; Middle Aged; Patients; People and Places; Radiofrequency ablation; Rank tests; Republic of Korea - epidemiology; Research and Analysis Methods; Risk Factors; Sinuses; Stroke; Stroke - epidemiology; Stroke - etiology; Systematic review; Treatment outcome; Veins & arteries; Working groups; Republic of Korea; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0201061

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.