Abstract Body (Do not enter title and authors here): Background: Ischemic stroke incidence after catheter ablation is historically reported at 0.2-0.3%. With advancements in catheter design, mapping, ablation techniques, and reduced ablation times, it is pertinent to reevaluate stroke incidence. We aim to determine the rates of procedural stroke in a contemporary patient series and characterize the clinical profiles associated with procedure-related Ischemic stroke.

Methods: All patients undergoing AF ablation from 2013 to 2021 at our center were enrolled in a prospective registry for outcomes and procedural complications and an automated platform for patient reported outcomes (AF symptom severity score, QoL, AF burden). Peri-procedural anticoagulation was continued peri-procedurally with therapeutic INRs or holding one dose of apixaban or dabigatran the morning of the procedure. Patients who experienced an ablation-related ischemic stroke or transient ischemic attack (TIA) were identified and compared to the general population of patients undergoing ablation.

Results: Of 7020 patients undergoing ablation, only 8 had an ischemic cerebrovascular event (0.11%, 5 strokes, 3 TIAs). The average age was similar in stroke patients (66 years) and the general cohort (65 years). The average CHA₂DS₂Vasc score was higher in the stroke group (2.6) compared to the general cohort (2.3), with larger left atrial diameter (4.5 cm vs. 4.2 cm) and a more frequent history of TIA (11% vs. 3.2%). AF burden was higher in stroke patients at baseline with higher AF frequency scores (8.8 vs 6.8) and higher AF duration scores (10 vs. 7.0 in controls). Other characteristics of patients with ischemic cerebrovascular events are summarized in table. All but one patient recovered without residual neurological deficits.

Conclusion: In this contemporary cohort of patients undergoing ablation, procedural related ischemic stroke incidence was 0.11% and associated with higher CHA₂DS₂Vasc score, larger atria, and baseline AF burden. This suggests that stroke rate is lower in modern practice versus historical cohorts.