Atrial fibrillation (AF) is a known risk factor for ischemic strokes, and catheter ablation is a recognized method for reducing this risk by restoring normal heart rhythm. However, despite its success in improving patients' quality of life, some still experience strokes post-ablation.

This study aimed to analyze data from 156 patients admitted to the University of Texas Medical Branch's stroke service with ischemic strokes or transient ischemic attacks (TIA) and comorbid AF between January 2022 and September 2023. This data included critical patient demographics such as age, gender, ethnicity, and comorbid conditions like hypertension, hyperlipidemia, and diabetes mellitus.

This study is a retrospective observational study.

Our findings revealed that of 156 patients, 15% (22) experienced post-ablation strokes. No significant gender disparity was found (13 males and 9 females). Among these post-ablation stroke patients, non-Hispanic Caucasians were the majority (73%). Comorbidity analysis unveiled high prevalence rates of vascular risk factors: 82% had hypertension, 64% had hyperlipidemia, and 45% had diabetes mellitus. Additionally, 13 out of 22 (59%) were on anticoagulation. In terms of stroke etiology, 43% were determined to be cardioembolic, 39% TIA, 4% small vessel disease, and 8% unknown (large vessel vs. cardioembolic).

These findings indicate a substantial burden of ischemic stroke risk in AF patients despite ablation. The study highlights the importance of gender, ethnicity, and comorbidities in post-ablation stroke risk, emphasizing the need for a comprehensive approach to intervention strategies. This research is critical for evaluating whether vascular risk factors have cumulative effects on stroke risk post-ablation. Atrial fibrillation ablation reduces stroke risk but doesn't guarantee complete protection, emphasizing the need for further research to identify predictors of post-ablation ischemic strokes. Our study findings also warrant further research in patient selection for ablation procedures to prevent ischemic strokes in patients with atrial fibrillation.