Does catheter ablation for atrial fibrillation increase or reduce neurological insult?

PURPOSE OF REVIEW: This article will review the periprocedural and long-term risk of stroke and other adverse neurological outcomes in patients having catheter ablation of atrial fibrillation. RECENT FINDINGS: Randomized trials of medication-based rhythm control for atrial fibrillation have failed to demonstrate a reduction in stroke. There is hope that catheter ablation of atrial fibrillation may provide such a benefit; however, definitive clinical trials have yet to be completed. It is well established that catheter ablation of atrial fibrillation is associated with a risk of periprocedural stroke; however, new studies using magnetic resonance imaging suggest that silent cerebral infarction is 10 times more common than clinical stroke. Studies which have systematically screened for silent cerebral infarction have been invaluable in refining the technique of atrial fibrillation catheter ablation, by identifying procedural details and ablation technologies which are more likely to result in this surrogate outcome. There is also early suggestion that these silent infarctions may be associated with longer-term adverse neuropsychological outcomes. SUMMARY: A more precise understanding of neurological injury with catheter ablation of atrial fibrillation is helping to refine this technique and will ultimately help determine if the prevention of recurrent atrial fibrillation with catheter ablation can reduce the risk of stroke.