# Vroege katheterablatie verlaagt MACE bij atriumfibrilleren na een beroerte *geplaatst 2026-10-11 · Atriumfibrilleren · Neurology · doi 10.1212/WNL.0000000000218568 · https://hartvaat.nl/2026/10/27/vroege-katheterablatie-verlaagt-mace-bij-atriumfibrilleren-na-een-beroerte/* Een retrospectieve target trial-emulatie onder 431 patiënten met atriumfibrilleren en een voorgeschiedenis van ischemische beroerte toonde aan dat vroege katheterablatie (binnen één jaar) na drie jaar leidt tot een gemiddelde winst van 1,54 MACE-vrije maanden en een absolute risicoreductie van 11,2% vergeleken met medicamenteuze therapie alleen. Daarnaast werd een lagere kans op cardiovasculaire rehospitalisatie, verbeterde functionele uitkomsten (mRS) en minder cognitieve achteruitgang geassocieerd met de ablatie. Hoewel het onderzoek beperkingen kent door de retrospectieve opzet en mogelijke residual confounding, ondersteunt het de overweging van ablatie als aanvullende strategie bij deze hoogrisicogroep naast geoptimaliseerde secundaire preventie. ## English: Early Catheter Ablation for Patients With Atrial Fibrillation and a Stroke History: A Target Trial Emulation Analysis. In a target trial emulation of 431 patients with atrial fibrillation and prior ischemic stroke, early catheter ablation within one year was associated with a 1.54-month gain in MACE-free survival at 36 months and an absolute risk reduction of 11.2% compared with medical therapy alone. The intervention also correlated with lower rates of cardiovascular rehospitalization, improved functional status (mRS), and reduced odds of cognitive impairment. While limited by its retrospective observational design and single-region cohort, the findings support considering early ablation as a viable adjunct to guideline-directed medical therapy in this high-risk population. ## Abstract (original, from the publication) BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is a major contributor to ischemic stroke, yet evidence on whether catheter ablation improves outcomes in patients with AF and a history of stroke remains limited. We emulated a target trial using observational data to estimate the effect of early catheter ablation vs medical therapy on clinical outcomes in this high-risk population. METHODS: We retrospectively included patients aged 18-85 years with AF and a history of ischemic stroke from 6 Chinese centers between January 2019 and December 2024. The primary outcome was major adverse cardiovascular events (MACEs). Secondary outcomes included all-cause rehospitalization, cardiovascular rehospitalization, all-cause death, and functional and cognitive outcomes assessed by modified Rankin Scale (mRS) and post hoc AD8 scores. A cloning-censoring-weighting approach was used to emulate a target trial comparing early ablation (within a 1-year grace period) and medical therapy in time-dependent outcomes, using weighted Kaplan-Meier curves. Restricted mean survival time (RMST) was used when the proportional hazards assumption was violated. mRS and AD8 were assessed after propensity score matching. RESULTS: A total of 431 patients were included (median age, 70 years; 37% female), of whom 207 underwent early catheter ablation. The median follow-up was 3.0 years. At 36 months, early ablation was associated with a gain of 1.54 MACE-free months (95% CI 0.40-2.85; p = 0.016) and an absolute risk reduction of 11.17% (95% CI 5.81%-17.36%; p < 0.001). Cardiovascular rehospitalization showed a higher 36-month event-free survival rate in the ablation group (absolute difference 11.98%; 95% CI 2.26%-21.44%; p = 0.018). In the matched cohort (n = 250), ablation was associated with better mRS scores (adjusted odds ratio 0.31; 95% CI 0.19-0.51; p < 0.001) and, in a post hoc cognitive assessment using AD8, lower odds of cognitive impairment (adjusted odds ratio 0.42; 95% CI 0.24-0.72; p = 0.002). DISCUSSION: In this target trial emulation analysis, catheter ablation was associated with a modestly lower long-term risk of MACE in patients with AF and a stroke history. Secondary analyses suggested exploratory associations between ablation and lower long-term cardiovascular rehospitalization, and better neurologic and cognitive outcomes. Major limitations include the retrospective design and potential residual confounding. Randomized trials with larger sample sizes are warranted. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that early catheter ablation in adult patients with AF and a history of ischemic stroke decreases the risk of MACEs compared with guideline-directed medical therapy. Auteurs: Hengzhi Zhang, Yuqian Gu, Chenwei Shang, Enming Cui, Haocen Guo, Qiuheng Bian, Youmei Shen, Zhoushan Gu, Xiangwei Ding, Linlin Wang, Boshui Huang, Xuefeng Zhu, Mingfang Li, Hongwu Chen, Weizhu Ju, Gang Yang, Kai Gu, Hailei Liu, Minglong Chen --- Bron: Neurology, https://doi.org/10.1212/WNL.0000000000218568. Bijgewerkt 2026-10-04T01:07:51Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.