In this episode of Voice of Stroke, we explore the latest evidence shaping stroke prevention in atrial fibrillation (AF) – a condition responsible for up to a quarter of all ischaemic strokes.

This episode examines emerging strategies and unresolved questions in AF management, including:

• Whether left atrial appendage closure (LAAC) can replace anticoagulation in patients eligible for oral therapy
• The role of catheter ablation in reducing recurrent stroke risk after AF-related stroke
• New population data on blood pressure control and stroke risk, particularly in younger AF patients

Key insights:

• Anticoagulation remains the cornerstone of stroke prevention, but limitations persist
• LAAC may reduce bleeding risk but does not yet clearly outperform anticoagulation in eligible patients
• Catheter ablation did not reduce recurrent stroke risk in current trial evidence
• Blood pressure is a critical—and potentially under-recognised—driver of stroke risk in AF, especially in younger populations

Together, these findings refine how we approach AF stroke prevention, balancing procedural interventions, pharmacological therapy, and risk factor management.

This episode was written by Voice of Stroke Podcast editor Umberto Pensato and Editor-in-Chief Linxin Li.

Read the full transcript here: https://eso-stroke.org/wp-content/uploads/ESO-Podcast-EP3_Transcript.pdf

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References

Landmesser U et al. Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation. N Endl J Med. 2026; 394: 1270-1280. doi: 10.1056/NEJMoa2513310. https://www.nejm.org/doi/full/10.1056/NEJMoa2513310

Doshi SK et al. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. N Engl J Med. 2026 Mar 28. doi: 10.1056/NEJMoa2517213 https://www.nejm.org/doi/full/10.1056/NEJMoa2517213

Kimura K et al. Catheter Ablation and Oral Anticoagulation for Secondary Stroke Prevention in Atrial Fibrillation: The STABLED Randomized Clinical Trial. JAMA Neurol. 2026 Mar 2:e260155. doi: 10.1001/jamaneurol.2026.0155. https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745

Jeong MH et al. Impact of blood pressure on the risk of stroke and all-cause mortality in patients with atrial fibrillation across different age groups: a nationwide population-based study. Heart Rhythm. 2026 Mar 24:S1547-5271(26)02172-7. doi: 10.1016/j.hrthm.2026.03.1917. https://www.heartrhythmjournal.com/article/S1547-5271(26)02172-7/fulltext