Catheter Ablation vs. Edoxaban Alone for Secondary Stroke Prevention: The STABLED Trial

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Summary of  JAMA Neurology. https://doi.org/10.1001/jamaneurol.2026.0155  
Dr. Kazumi Kimura  et al.

Points

Researchers conducted a nationwide randomized trial to determine if combining catheter ablation with edoxaban could reduce recurrent stroke risks in patients already diagnosed with atrial fibrillation.
The study found that adding the ablation procedure to standard anticoagulant therapy did not result in a statistically significant reduction in major cardiovascular events or secondary stroke occurrences.
Results showed an annual event rate of five point six percent in the ablation group compared to four point nine percent for those receiving only oral anticoagulant medication.
Investigators suggested that the clinical trial might have been underpowered because the overall observed event rates were lower than the seven to ten percent originally anticipated for this population.
Further scientific research is necessary to identify if modern improvements in catheter ablation technology or refined patient selection could eventually provide better outcomes for high-risk stroke survivors.

Summary

This study evaluated the efficacy of adding catheter ablation to standard edoxaban therapy for secondary stroke prevention in patients with atrial fibrillation and a recent history of ischemic stroke. Given that patients with prior stroke face recurrence rates between 7% and 10% annually despite direct oral anticoagulant (DOAC) use, the STABLED randomized clinical trial sought to determine if rhythm control via ablation could further mitigate cardiovascular risk. The nationwide study enrolled 251 participants across 45 medical institutions in Japan to compare the primary composite outcome of recurrent stroke and major cardiovascular events.

The results demonstrated that the routine addition of catheter ablation did not significantly reduce the risk of the primary composite endpoint. Over a median follow-up of three years, the event rate was 5.6% per person-year in the ablation plus edoxaban group compared to 4.9% per person-year in the group receiving edoxaban alone. These statistically non-significant findings indicate that restorative rhythm control through current ablation techniques may not offer a clear clinical advantage over standard anticoagulation for this specific high-risk population.

The researchers noted that the observed overall event rates were lower than anticipated, suggesting the trial may have been underpowered to detect smaller but clinically meaningful differences. While the findings currently do not support a practice-changing shift for secondary prevention in post-stroke atrial fibrillation patients, the study highlights the complexity of managing this cohort. Further research is required to evaluate if advances in ablation technology or more precise patient selection protocols could yield therapeutic benefits that were not captured in this nationwide analysis.

Link to the article: https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745

References


Kimura, K., Nishiyama, Y., Iwasaki, Y., Shimizu, W., Toyoda, K., Sakamoto, Y., Katano, T., Yamamoto, T., Takeuchi, M., Kumagai, K., Tsuto, K., Sugi, K., Kusano, K., Koga, M., Okubo, S., Sato, T., Hamaguchi, H., Yoshida, A., Kuriki, A., … Okumura, K. (2026). Catheter ablation and oral anticoagulation for secondary stroke prevention in atrial fibrillation: The stabled randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2026.0155