Atrial ﬁbrillation ablation patients have long-term stroke rates similar to patients without atrial ﬁbrillation regardless of CHADS2 score
Atrial ﬁbrillation (AF) is a leading cause of total and fatal ischemic stroke. It is estimated that AF accounts for 15% of all strokes. Furthermore, in patients who have no immediate cause of stroke identiﬁed, AF is often documented subsequently with extended monitoring. The ﬁnding of subsequent atrial tachyar- rhythmias also conveys an additional risk of subsequent stroke.
In AF patients, the CHADS2 risk score has reproducibly identiﬁed patients who have higher risks of stroke. In addition, the CHADS2 score risk factor components have prognostic value for general cardiovascular morbidity and mortality risk.
Recently, rhythm control strategies have emerged as possible tools to decrease stroke risk in AF patients. For example, in the ATHENA trial, dronedarone-treated patients had a lower stroke risk over the study follow-up compared to those who received placebo. Regarding nonpharmacologic treatment, we examined stroke risk after ablation and found a lower overall risk compared to AF patients not treated with ablation. Furthermore, we found that the stroke risk over time of AF patients treated with ablation was similar to patients with no history of AF. Also, AF patients after ablation with moderate to high risk CHADS2 scores in which warfarin was discontinued do not show a higher risk of stroke compared to those in which warfarin is continued.