Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history: a prospective propensity score-matched cohort study

BACKGROUND Patients with atrial fibrillation(AF) and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy. It is unclear whether catheter ablation(CA) has further benefits in these patients.METHODS AF patients with a previous history of stroke or systemic embolism(SE) from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis. Patients were matched in a 1:1 ratio to CA or medical treatment(MT) based on propensity score. The primary outcome was a composite of all-cause death or ischemic stroke(IS)/SE.RESULTS During a total of 4.1 ± 2.3 years of follow-up, the primary outcome occurred in 111 patients in the CA group(3.3 per 100 person-years) and in 229 patients in the MT group(5.7 per 100 person-years). The CA group had a lower risk of the primary outcome compared to the MT group [hazard ratio(HR) = 0.59, 95% CI: 0.47–0.74, P < 0.001]. There was a significant decreasing risk of all-cause mortality(HR = 0.43, 95% CI: 0.31–0.61, P < 0.001), IS/SE(HR = 0.73, 95% CI: 0.54–0.97, P = 0.033), cardiovascular mortality(HR = 0.32, 95% CI: 0.19–0.54, P < 0.001) and AF recurrence(HR = 0.33, 95% CI: 0.30–0.37, P < 0.001) in the CA group compared to that in the MT group. Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.CONCLUSIONS In AF patients with a prior stroke history, CA was associated with a lower combined risk of all-cause death or IS/SE. Further clinical trials are warranted to confirm the benefits of CA in these patients.