Abstract Body: Introduction: Catheter ablation (CA) is superior to medical therapy in the management of atrial fibrillation (AF). Current guidelines do not take into consideration the history of CA or its outcome when recommending chronic oral anticoagulation (OAC). The current clinical practice of prescribing (OAC) in patients with history of CA and how it relates to CVA is not well described.

Objective: To investigate patterns, including modifiable and non-modifiable commonalities, in patients with atrial fibrillation and history of catheter ablation experiencing stroke

Methods: We included patients who underwent a catheter ablation for symptomatic AF between 2014 and 2022 in one of eight hospitals in a large healthcare system and had at least a 1 year follow up after their procedure. A detailed query of our common inpatient and outpatient medical record was performed for medications including prescription and adherence to OAC, as well as occurrence of CVA post ablation.

Results: Out of 2313 AF patients who underwent CA, 32 (1.4%) had a CVA (6 TIA, 26 stroke) within 5 years of ablation (Table 1). The median follow-up duration for the patient population was 1168 days post-ablation. Catheter ablation was presumed successful in 19/32 patients who experienced a CVA. Of the 32 who had a stroke event, 24 had ischemic strokes, 7 hemorrhagic, and 1 of unknown mechanism. Amongst those who had an ischemic stroke, 10 (41.7%) were cardioembolic. Within the cardioembolic stroke subgroup, 60.0% were on OAC (5 on Apixaban, 1 on Rivaroxaban) at the time of stroke, nearly a third (30.0%) had an elevated PT, and only half had evidence of AF recurrence prior to stroke (Table 2).Patients with CVA compared to those without were younger (Age 64.9 vs 69.6) and more likely to have coronary artery disease, peripheral artery disease, and chronic liver disease (p < 0.05), however they had similar CHADVASC scores (3.09 vs 2.74). In addition, no difference was found in recurrence of AF between the 2 groups. Patients with stroke had a greater 12-month mortality(Table 3).

Conclusions: CVA occurred in 1.4% of patients with AF within 5 years after AF ablation. This study reports no difference in thromboembolic risk, compliance of OAC and recurrence of AF suggesting that CA might not affect the thromboembolic risk in such a period of time. Further studies are required to assess the effects of CA on long term cardioembolic risk.