Ablation of atrial fibrillation and risk of stroke: A meta-analysis
Rui Providência, Hussam Ali, Sérgio Barra, António Creta, Kishore Kukendrarajah, Prapa Kanagaratnam, Michał M. Farkowski, Riccardo Cappato
Abstract
BACKGROUND: Despite treatment with anticoagulants, patients with atrial fibrillation (AF) remain exposed to a relevant residual risk of stroke. It remains to be proven whether catheter ablation of AF can lead to an additional stroke protection benefit in these patients. OBJECTIVE: This study aimed to investigate a possible stroke protective benefit by catheter ablation in AF. METHODS: -VASc of ≥2 or <2, paroxysmal/persistent AF, early ablation, studies allowing discontinuation of oral anticoagulation after ablation, higher/lower quality, published ≤5 vs >5 years ago, and ≥12- vs <12-month follow-up. RESULTS: = 0), and a number needed to treat of 78.7 patients to prevent 1 stroke. Subgroup and sensitivity analyses yielded similar estimates with 30%-40% RR reduction for all subanalyses, except for trials with less than 1 year of follow-up. CONCLUSION: Pooling of high-quality RCT data suggests that catheter ablation may lead to significant stroke reduction. A confirmatory trial will be required to provide a conclusive answer to this matter.