Catheter Ablation Does Not Reduce Composite Outcomes in AF Patients With Recent Stroke: JAMA

A new study published in the Journal of American Medical Association showed that adding catheter ablation to conventional treatment did not significantly reduce the risk of the primary composite end point in individuals with atrial fibrillation and a recent history of stroke.

Patients with atrial fibrillation who have recently experienced a stroke are far more likely to experience another episode than those who have not. It is anticipated that catheter ablation will lower the mortality, heart failure, and recurrent stroke risks of these patients. In patients with atrial fibrillation with a recent history of stroke, this study assessed the safety and effectiveness of catheter ablation added to conventional treatment for lowering the risk of recurrent stroke or composite outcomes.

This clinical trial, Stroke Secondary Prevention With Catheter Ablation and Edoxaban for Patients With Nonvalvular Atrial Fibrillation (STABLED) monitored patients until March 2024 after being enrolled between January 2018 and March 2021. This investigation was carried out in 45 locations around Japan.

Patients were enrolled if they were 20 years of age or older, 85 years of age or younger, had a history of ischemic stroke, were receiving or scheduled to receive edoxaban, had a modified Rankin Scale score of 3 or lower, and had a definitive diagnosis of nonvalvular atrial fibrillation on an ECG. The patients were randomly assigned to either normal therapy or standard therapy with catheter ablation.

251 patients in all were recruited, and 249 of them (mean [SD] age, 71.7 [7.5] years; 187 male [75.1%]) were randomly assigned to receive either conventional therapy (124) or standard therapy + catheter ablation (125). The median follow-up period exceeded 3 years. With conventional treatment vs catheter ablation, the major end goal happened at rates of 4.9% and 5.6% per person-year (hazard ratio, 1.11; 95% CI, 0.62-2.01), respectively.

The death rates were 1.0 and 2.8 per 100 person-years, respectively. Heart tamponade and stroke were the two adverse events associated with ablation that were documented (0.8% each). Overall, these results suggest that the addition of catheter ablation to conventional treatment did not significantly lower the risk of the primary composite end objective in patients with atrial fibrillation and a recent history of stroke.

Reference:

Kimura, K., Nishiyama, Y., Iwasaki, Y.-K., Shimizu, W., Toyoda, K., Sakamoto, Y., Katano, T., Yamamoto, T., Takeuchi, M., Kumagai, K., Tsuto, K., Sugi, K., Kusano, K., Koga, M., Okubo, S., Sato, T., Hamaguchi, H., Yoshida, A., Kuriki, A., … Okumura, K. (2026). Catheter ablation and oral anticoagulation for secondary stroke prevention in atrial fibrillation: The STABLED randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2026.0155