BACKGROUND: Inadequate management of atrial fibrillation (AF) after stroke is associated with a worse prognosis, and the impact of early rhythm control with catheter ablation (CA) on neurological outcomes in these patients is poorly understood. OBJECTIVES: This study sought to evaluate the impact of early rhythm control with CA in patients with new-onset AF at the time of stroke. METHODS: We performed a retrospective, observational study of patients hospitalized with stroke and new-onset AF from 2021 to 2023. Patients underwent routine care (n = 36) with rate control or antiarrhythmic drugs or rhythm control with CA (n = 36) after discharge. Functional neurological outcomes at admission, discharge, and 6 and 12 months were measured using the modified Rankin score-a scoring system from 0 to 6, describing patient activity levels. AF-related outcomes are also measured. RESULTS: Though the modified Rankin score was similar at admission (4.5 ± 1.0 vs 4.4 ± 1.0
P = 0.717) and discharge (4.23 ± 0.7 vs 4.2 ± 0.8
P = 0.656), it was lower at 6 months (2.0 ± 0.7 vs 3.5 ± 0.8
P <
0.001) and 12 months (1.1 ± 0.8 vs 3.0 ± 1.0
P <
0.001) for those that underwent CA. They also had a faster time to rhythm control (54.5 ± 15.6 days vs 73.1 ± 26.3 days
P <
0.001) and continued AF freedom at 12 months (100% vs 13.9%
P <
0.001), with fewer repeat strokes (0% vs 13.9%
P = 0.091), major bleeding (11.1% vs 25%
P = 0.126), number of hospitalizations (0.4 ± 0.8 vs 1.8 ± 1.5
P <
0.001), and mortality (0% vs 11.1%
P <
0.001). CONCLUSIONS: Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in the study populations, it is uncertain whether these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.