Background: Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. This study investigated the incidence and mode of stroke recurrence in patients with a history of stroke who underwent atrial fibrillation (AF) ablation. Methods:Of 825 patients who underwent AF ablation from 2006 to 2016, 77 patients (9.3%, median age 69 years) with a prior ischemic stroke were identified.Patients were classified as those with prior cardioembolic (CE) stroke (n = 55) and those with prior non-CE stroke (n = 22). The incidence and pattern of stroke recurrence were investigated. Results:The incidence of asymptomatic AF (54.5% vs 22.7%; P = .011) and left atrial volume (135.8 mL vs 109.3 mL; P = .024) was greater in the CE group than in the non-CE group. Anticoagulation treatment was discontinued at an average of 28.1 months following the initial ablation in 34 (44.2%) patients. None of the patients developed CE stroke during a median 4.1-year follow-up. In the non-CE group, 2 patients experienced recurrent non-CE stroke (lacunar infarction in 1 and atherosclerotic stroke in 1); however, AF was not observed at the onset of recurrent ischemic stroke. Conclusions:In patients with a history of stroke who underwent catheter ablation for AF, the incidence of recurrent stroke was 0.54/100 patient-years. The previous stroke in these patients may not have been due to AF in some cases; therefore, a large-scale prospective study is warranted to identify the appropriate antithrombotic therapy for the prevention of potentially recurrent stroke.

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Background: Ventricular arrhythmia inducibility is one of the ideal endpoints of ventricular tachycardia(VT) ablation. However, it may be challenging to implement programmed electrical stimulation (PES) at the end of the procedure under several circumstances. The long-term outcome of patients who did not undergo PES after VT ablation remains largely unknown.Purpose: To investigate the details and long-term outcome of VT ablation in patients who did not undergo PES at the end of the ablation procedure. Methods: Among 184 VT ablation procedures in patients with structural heart disease who underwent VT ablation using an irrigated catheter, we enrolled those who did not undergo PES after VT ablation. VT ablation strategy involved targeting induced VT plus pacemap-guided substrate ablation if inducible. If VT was not inducible, substrate-based ablation was performed. The primary endpoint was VT recurrence. Results: In 58 procedures, post-ablation VT inducibility was not assessed. The causes were non-inducibility of sustained VT before ablation(27/58, 46.6%), long procedure time(27.6%, mean 392 min), complications(10.3%), intolerant hemodynamic state(10.3%), and inaccessible or unsafe target(6.9%). With regard to the primary endpoint, 23 recurrences(39.7%) were observed during a mean follow-up period of 2.5 years. Patients with non-inducibility before ablation showed less VT recurrences(4/27, 14.8%) during follow-up than patients with other causes of untested PES after ablation(19/31, 61.2%)(Log-rank<0.001). Conclusions: VT recurrence was not observed in approximately 60% of the patients who did not undergo PES at the end of the ablation procedure. PES after VT ablation may be not needed among patients with pre-ablation non-inducibility.

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