Abstract 18414: Risk of Stroke After Atrial Fibrillation Ablation in Patients Without Pre-Ablation Left Atrial Appendage Evaluation

Abstract

Introduction: Currently, transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), or CT angiography (CTA) are often though not always performed to assess the left atrial appendage (LAA) prior to ablation to reduce the risk of stroke. We seek to evaluate in a large, real-world registry if rates of stroke are similar in patients who do not have this evaluation and are on at least three weeks of anticoagulation prior to ablation. Methods: The REAL-AF registry is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. Data from a total of 2704 patients (mean age 66 ± 11 years, 42% female) receiving index ablation for paroxysmal and persistent AF were obtained and included in the analysis. The patients who suffered strokes within 12 months of ablation were analyzed. Results: A total of 1522 (56%) patients received TEE, 1143 (42%) received ICE, 153 (6%) received both TEE and ICE, 95 (4%) received CTA, and 97 (4%) did not received any evaluation for LAA clots pre-ablation. CHA 2 DS 2 VASc was significantly higher in the not screened group compared to the screened group ((3.18 [2.84 - 3.51]) vs 2.65 [2.59 - 2.71], p < 0.01). Three patients (0.1%) suffered strokes after ablation, two who had been screened by ICE, and one who had not been screened. No patients who were screened by TEE or CTA suffered strokes. All three patients with strokes were on therapeutic oral anticoagulation prior to ablation. The two patients screened with ICE had a CHA2DS2VASC of 2 and 7, while the patient without screening had a score of 6. Patients who were not screened had a statistically significant higher likelihood of having a stroke compared to those who received LAA screening with TEE, ICE, or CTA (OR = 13.2 [1.2 - 147], p = 0.04). Conclusion: While absolute rates of stroke after AF ablation are low, in our cohort occurring in only 0.1% of patients, there was a statistically significantly higher odds of developing stroke in patients who did not have their LAA screened prior to ablation.