Catheter ablation for atrial fibrillation (AF) is a validated therapy for patients with symptomatic AF to prevent recurrences. However, the influence of AF catheter ablation on ischemic stroke (IS) occurrence is unclear and debated.

We aimed to compare the incidence of IS in patients after AF catheter ablation versus patients not treated with AF ablation.

This French longitudinal cohort study was based on the national hospitalization PMSI (Programme de Médicalisation des Systèmes d’Information) database covering hospital care from the entire population. We included all patients, over 18 years old, with AF from January 2010 to December 2015. Items from the baselines characteristics were pooled into a Cox model to identify predictors of IS.

Of 1,663,284 patients identified with AF, 28,018 patients were treated with AF ablation (28% female, mean age 60±10 years old, mean follow-up 700±603 days) and 1,635,266 patients did not have AF ablation (48% female, mean age 77±12 years old, mean follow-up 463±550 days). IS during follow-up was recorded in 48,766 patients (yearly rate 2.31%). Incidence of IS was lower in the AF ablation group (0.52% person per year versus 2.33% person per year; P<0.0001). For each category, patients treated with AF ablation or no AF ablation, IS incidence was lower in the AF ablation group. In multivariable analysis, AF catheter ablation was independently associated with a lower rate of IS during FU (HR=0.50, CI % 0.45–0.57, P<0.0001) after adjustment on age, gender and CHA2DS2-VASc score.

Ablation may be associated with lower incidence of IS in patients with AF, independently of CHA2DS2-VASc score. This beneficial finding was similar in patients with low or higher thromboembolic risk. This suggests that AF ablation may be an adjunctive therapy, in addition to oral anticoagulation therapy, for prevention of IS in AF patients.