Ann Intern Med

Catheter ablation lowers stroke and death in afib, early procedural risks persist

July 8, 2025

Catheter ablation confers long-term reductions in stroke, mortality, and HF hospitalization in afib, but carries a notable early procedural stroke risk. Surgical ablation appears to reduce stroke but has less certain benefit for other outcomes. Clinical heterogeneity and lack of participant-level data limit generalizability, but these results support ablation as a disease-modifying intervention beyond rhythm control.

Study details: This systematic review and meta-analysis included randomized trials comparing catheter or surgical ablation with no ablation in patients with afib, with at least one month of follow-up and reporting on stroke and/or mortality. The search spanned nine databases from 1987 to May 2025, with dual independent data extraction and risk-of-bias assessment.

Results: Catheter ablation was associated with reduced risk of ischemic stroke after 30 days (relative risk [RR], 0.63; 95% confidence interval [CI], 0.43–0.92), all-cause mortality (RR, 0.73; 95% CI, 0.60–0.88), and HF hospitalization (RR, 0.68; 95% CI, 0.55–0.85) compared with medical therapy. However, there was a significant increase in early (≤30 days) ischemic stroke risk (RR, 6.81; 95% CI, 1.56–29.8). Surgical ablation reduced ischemic stroke risk (RR, 0.54; 95% CI 0.34–0.86) but showed uncertain benefit for mortality and HF hospitalization.

Source:

Montané B, et al. (2025, July 1). Ann Intern Med. Catheter and Surgical Ablation for Atrial Fibrillation : A Systematic Review and Meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40587868/