5.1 RFCA and ischemic stroke
Previous observational studies suggest that RFCA can reduce the risk of
ischemic stroke in AF patients. A nationwide cohort data from Sweden,
RFCA was associated with a 31% reduction of ischemic stroke with the
benefit more prominent in AF patients with
CHA2DS2-VASc ≥ 2 (hazard ratio =
0.39).16 Noseworthy and
his colleagues reported a 44% reduction in the risk of ischemic stroke
for those who met the inclusion criteria of CABANA trial using a
retrospective cohort of 183,760 AF
patients.15 The CABANA
trial itself disabling stroke occurred in 3 and 6 patients in RFCA and
medical treatment group, respectively (hazard ratio = 0.42; p
< 0.19).21The CASTLE-AF trial reported a statistically insignificant 54%
reduction in the risk of cerebrovascular accident in RFCA group compared
to medical treatment group (p =
0.014).14 Despite
statistical insignificance in randomized clinical trials, numerical
reduction in the risk of ischemic stroke and lack of statistical power
due to small sample size should be taken in to account.