The “sentinel stroke”: catheter ablation outcomes in patients with atrial fibrillation detected after stroke

Background A subset of patients with atrial fibrillation (AF) first present with ischemic stroke. After neurological recovery, catheter ablation (CA) may be considered in arrhythmia clinic. However, outcomes of CA in patients with atrial fibrillation detected after stroke (AFDAS) remain insufficiently characterized compared with people with previously known AF (KAF). Methods We conducted a retrospective analysis of consecutive patients who underwent catheter ablation between January 2023 and October 2024 in a special arrhythmia ward. Propensity score matching was performed to balance baseline characteristics. Outcome analyses were restricted to the matched cohort. The primary endpoint was freedom from atrial arrhythmia. The key secondary endpoint was a composite of all-cause death, stroke, or cardiovascular rehospitalization. Results Among 3,417 eligible patients, 232 were included in the matched analysis (48 AFDAS, 184 KAF). AFDAS patients had numerically lower 2-year atrial arrhythmia recurrence rates [14.6% vs. 22.1%; HR 0.70, (95% CI 0.31–1.57); log-rank P = .39], although the difference was not statistically significant. The incidence of the key secondary endpoint was also similar between groups [9.2% vs. 14.1%; HR 0.73, (95% CI 0.28–1.90); log-rank P = .52]. Conclusion In this propensity score-matched cohort, CA was associated with comparable efficacy and safety outcomes in AFDAS and KAF patients. Larger prospective studies are needed to further clarify long-term outcomes in this population.