Left atrial catheter ablation and ischemic stroke

Haeusler, Karl Georg; Kirchhof, Paulus; Endres, Matthias

doi:10.1161/strokeaha.111.627067

Cited by 77Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsAcute Ischemic Stroke Management

Left atrial catheter ablation and ischemic stroke

Haeusler, Karl Georg, Kirchhof, Paulus, Endres, Matthias·2012·Stroke

DOI 10.1161/strokeaha.111.627067

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Abstract

Left atrial catheter ablation (LACA) has become an established therapy to abolish drug-refractory symptomatic paroxysmal and persistent atrial fibrillation. Restoring sinus rhythm by LACA may help to prevent atrial fibrillation-related strokes, but presently there is no evidence from randomized clinical trials to support this notion. This review summarizes the current knowledge and uncertainties regarding LACA and procedure-related ischemic stroke. In fact, most patients who undergo LACA have a rather low annual stroke risk even when left untreated, whereas LACA imposes a risk of procedure-related stroke of ≈0.5% to 1%. In addition, LACA may cause cerebral microemboli, resulting in ischemic lesions. These cerebral lesions, detectable by high-resolution MRI, could contribute to neuropsychological deficits and cognitive dysfunction. Furthermore, recurrent atrial fibrillaton episodes can be detected up to years after LACA and might cause ischemic strokes, especially in those patients in whom therapeutic anticoagulation was discontinued. Further prospective multicenter trials are needed to identify procedure-dependent risk factors for stroke and to optimize postprocedural anticoagulation management.

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Silent strokes (white matter lesions detectable by brain MRI) have been observed in around 10% of patients treated with radiofrequency and cryoballoon ablation.
“'Silent strokes' (i.e.white matter lesions detectable by brain MRI), have been observed in around 10% of patients treated with radiofrequency and cryoballoon ablation.752”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [752]

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Authors: Haeusler, K. G., Kirchhof, P., & Endres, M.
Affiliations: From the Department of Neurology (K.G.H., M.E.), Charité–Universitätsmedizin Berlin, Germany; Center for Stroke Research Berlin (K.G.H., M.E.), Berlin, Germany; Department of Cardiology and Angiology (P.K.), University Hospital Münster, Münster, Germany; and University of Birmingham Center for Cardiovascular Sciences (P.K.), Birmingham, UK.
University Hospital Münster (DE)
ORCID: Kirchhof, Paulus
Endres, Matthias
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-01
Volume: 43
Issue: 1
Pages: 265-270
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/strokeaha.111.627067
OpenAlex: W2163415952
Cited by: 77
References: 54
Citations by year: 2026: 2 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 7 · 2014: 2 · 2013: 8 · 2012: 4
Type: journal article
Language: en
Open access: closed
Locations: Stroke (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords: left atrial catheter ablation, ischemic stroke, atrial fibrillation, cerebral microemboli, atrial fibrillation recurrence, anticoagulation, stroke risk factors, cognitive impairment, neuropsychological deficits
MeSH terms: Atrial Fibrillation, Brain Ischemia, Humans, Treatment Outcome, Catheter Ablation, Stroke

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Left atrial catheter ablation and ischemic stroke

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