Catheter ablation for atrial fibrillation (Afib) may be safe even for patients with a history of stroke, according to a single-center study.

Researchers found that none of their ablation patients with known prior cerebrovascular events had a peri-procedural embolic event in the following 3 months, and only 4% showed signs of bleeding complications.

"Patients with a prior history of cerebrovascular events do not seem to be predisposed to a significant risk of clinical risk of cerebrovascular event recurrence when undergoing catheter ablation for Afib without interruption of therapeutic anticoagulation,"Niraj Varma, MD, PhD, of the Cleveland Clinic, and colleagues reported in JACC: Clinical Electrophysiology.

"Patients that have Afib and have experienced a stroke are at much higher risk of developing a second stroke," T. Jared Bunch, MD, of Intermountain Healthcare in Murray, Utah, explained to MedPage Today in an email. "One of the most concerning risks of catheter ablation for Afib is a procedural stroke," so "it is conceivable that patients who have experienced a prior stroke may be at higher risk of developing a procedural stroke."

The new study seems to turn the assumptions on their head. "The findings imply that such patients should not be denied catheter ablation of Afib as a treatment option simply on the basis of their prior clinical history of cerebrovascular events," the authors concluded.



Bunch agreed, saying that the investigation might "alleviate fears of recurrent stroke in patients that have experienced a stroke and are considering an ablation as a treatment option."

Varma's analysis included 247 patients who received Afib ablation at the Cleveland Clinic -- between 2000 and 2014 – after being placed on an anticoagulant regime.

Varma's analysis included 247 patients who received Afib ablation at the Cleveland Clinic -- between 2000 and 2014 – after being placed on an anticoagulant regime.

The results highlighted "the importance of performing ablation without discontinuing or interrupting anticoagulation. Many prior studies have shown that this practice not only lowers risk of stroke and clot formation, but also lowers the risk of bleeding," according to Bunch.

Luigi Di Biase, MD, PhD, of Montefiore Medical Center in New York City, also told MedPage Today that the study confirmed that "uninterrupted" anticoagulation therapy is the "safest way to protect from peri-procedural stroke." This was previously reported in the COMPARE trial, which Di Biase co-authored.

Varma's study was "the largest to date to report on the safety of catheter ablation in patients with a prior history of a cerebrovascular event," according to its authors, adding that "the group of patients studied in the current analysis is important but significantly under-represented in prior studies. This likely reflects the fact that these patients are not frequently referred or offered ablation procedures due to potential risks."

Indeed, "it is important to note that these patients represent a carefully selected population," Mintu Turakhia, MD,of California's Palo Alta VA Health Care System, told MedPage Today in an email. While some of their prior strokes may not have been due to Afib, it was still "important to document a low peri-procedural stroke risk in this population."

The take-home is "for clinicians to understand that stroke or TIA is not a blanket contraindication to Afib ablation," Turakhia concluded.

Because Varma's study was performed at a single center, the authors expressed caution in interpreting their findings.

"Ablation protocols vary from one institution to another, especially in persistent Afib, and this may affect procedural duration and complications," the authors emphasized. "Even in our own institution, ablation protocols have evolved considerably during the course of the current study which spans 15 years."

They maintained, however, that their investigation "indicates that Afib ablation undertaken in patients with prior history of cerebrovascular events is not associated with a significant risk of clinical recurrence of such events and may be offered safely in selected cases with the strict anticoagulation protocols used."

"Even in high-risk patients that have experienced a stroke, procedural safety is preserved in these high volume centers," Bunch agreed.

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