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.