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2025 AF Symposium
Dhanunjaya Likkireddy MD
Real-World Problems of Stroke Patients with Atrial Fibrillation
One presenter during the Thursday afternoon’s “Late Breaking Clinical Science Session II” was Dr. Dhanunjaya Likkireddy of the Kansas City Heart Institute, Overland Park, KS.
Dr. Likkireddy described the predicament and challenges for Atrial Fibrillation patients who suffer a stroke.
After discharge, they often don’t have follow-up with a neurologist [a specialist who treats disorders including stroke]. “They lose their job, their friends, their family and they ultimately die.”
The Sober Facts About Stroke
Dr. Likkireddy pointed out that stroke is the number one cause of disability and the fifth leading cause of death in the U.S.
Strokes are either ischemic [blood clots which block blood flow] or hemorrhagic [bleeding in the brain].
Eighty percent of strokes are ischemic. Within 6 months, 20% of stroke victims experience repeated strokes. Recurring hospitalizations are common.
Atrial Fibrillation is an important risk factor for stroke and accounts for 25% of ischemic strokes.
The Kansas City Heart Institute found that more than 70 percent of these stroke victims experience some form of disability.
Yet Widely Inadequate Management After Stroke
Functional recovery after stroke is an important part of restoring people’s lives.
– Dr. Dhanunjaya Lakireddy
Inadequate management after stroke is widely prevalent. In Dr. Lakireddy’s words, there’s a “therapeutic black hole of A-Fib and stroke management.
This is something we should be able to really pick up on by making simple tweaks to their management.”
RESCUE-STROKE Pilot Study
Dr. Likkireddy described the RESCUE-STOKE study that looked at A-Fib patients who survived a stroke and the impact of subsequent treatments, i.e., Catheter Ablation versus conventional drug treatment.
In this small pilot study, researchers performed a retrospective, observational study of patients hospitalized with stroke and new-onset A-Fib from 2021 to 2023. They created two different study groups of stroke survivors who were diagnosed with A-Fib at the time of their stroke. (Anyone with a hemorrhagic stroke was excluded from the study.)
The first group had treatment with catheter ablation aimed at restoring and maintaining normal sinus rhythm. The second employed routine drug management (oral anticoagulants, antiarrhythmic drugs). Each group contained 36 patients for a total study population of 72.
Researchers followed the study patients for 12 months. They also collected data using loop recorders. They incorporated the results in a Modified Rankin Scale.
Study Results
Dramatic differences were found between the Catheter Ablation group and the Drug Management group. The Catheter Ablation group findings were significantly better including:
1. The number of repeat strokes decreased considerably (25% vs 8.3%).
2. Major bleeding decreased (25% vs 11%).
3. A-Fib-related hospitalizations decreased in a major way (69.4% vs 25.0%).
4. And most importantly, cumulative cardiovascular outcomes showed a major improvement (78.6% vs 25.0%).
Graphic: Early Catheter Ablation for Incident Atrial Fibrillation Post-Stroke Appears Associated With Improved Outcomes (RESCUE-STROKE)
In other words: Those that underwent Catheter Ablation reached rhythm control faster, with continued A-Fib freedom at 12 months; had fewer repeat strokes; and less major bleeding, number of hospitalizations, and mortality.
In Dr. Lakkireddy’s words, the Catheter Ablation group was significantly better “by a huge score”. The Catheter ablation group of patients benefited from early intervention, more directed care, and guided therapy.
Researchers Note: Because of important differences in the study populations, additional studies are needed.
Editor’s Comments
Editor’s CommentsThis study gives new hope to these unfortunate patients with both stroke and Atrial Fibrillation. According to Dr. Lakkireddy “it gives them an opportunity for a meaningful recovery.”
Stroke Survivors at Great Risk: Survivors of a stroke who also have or develop A-Fib are in a difficult situation (vs. A-Fib patients without stroke). Most have experienced some form of disability (70%). In addition, 20% of stroke survivors will have another stroke within 6 months.Early intervention with catheter ablation results in significant improvement in neurological outcomes, adverse events, and A-Fib-related outcomes.
For stroke survivors, A-Fib adds to their stroke risk. Dr. Lakkireddy paints a grim picture of their future. “They lose their jobs, their friends, their family, and they ultimately die.”
There is Real Hope for Stroke Survivors with A-Fib: The key is early intervention with catheter ablation which results in significant improvement in neurological outcomes, adverse events, and A-Fib-related outcomes.
Patients with early intervention had a faster time to rhythm control, continued freedom from A-Fib at 12 months, fewer repeat strokes, less major bleeding, less hospitalizations, and a major improvement in mortality (0% vs 11.1%).
We patients are most grateful to Dr. Lakkireddy and his colleagues for the hope he has provided to stroke survivors with A-Fib who often have a challenging road to recovery.
