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Publications

Journal Article Ahead of print 10 citations

PubMed: 41914181 DOI: 10.1093/eurheartj/ehag217

Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry.

Eur Heart J

Authors: Sergio Castrejón-Castrejón, Christian-Hendrik Heeger, Christian Veltmann, David Schaack, Moritz Nies, Melanie Gunawardene, Daniel Steven, Verena Tscholl, Laurent Roten, Philipp Sommer, Michael Spartalis, Julien Seitz, Peter M Kistler, Minglong Chen, Qunshan Wang, Freddy Del-Carpio Munoz, Adrianus P Wijnmaalen, Javier Moreno, Ramón Albarrán-Rincón, Prashanthan Sanders, Hermann Blessberger, Mikaël Laredo, Olaf Krahnefeld, Andrej Pernat, Charles Guenancia, Aapo Aro, Eduardo Castellanos Martínez, Fernando Scazzuso, Christian Sticherling, Kars Neven, Hikmet Yorgun, Jong-Il Choi, Andrea Natale, Alexandre Almorad, Boyoung Joung, Dan Wichterle, Martin H Ruwald, Serkan Cay, Antoine Andorin, Hiroyuki Kato, Guillermo Carnero, Aleksander Maciag, Svetlana Garkina, Jean-Claude Deharo, Mouhannad M Sadek, Yu-Ki Iwasaki, Thomas Beiert, Eue-Keun Choi, Dejan Kojic, João Sousa … and 25 other authors

Affiliations

  • Department of Cardiology, La Paz University Hospital, Paseo de la Castellana, nº 261, Madrid, PC 28046, Spain.
  • Department of Rhythmology, Klinik für Kardiologie und Innere Medizin, Asklepios Klinik Hamburg Altona, Hamburg, Germany.
  • Department of Rhythmology, UKSH Campus Lübeck, University of Lübeck, Lübeck,Germany.
  • Herzzentrum Bremen, Elektrophysiologie Bremen, Bremen, Germany.
  • Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
  • University Heart and Vascular Center, Hamburg, Germany.
  • Sklepios Klinik St. Georg, Hamburg, Germany.
  • Heart Center University Cologne, Köln, Germany.
  • Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany.
  • Charité -Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Heart- and Diabetescenter NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
  • National and Kapodistrian University of Athens, Athens, Greece.
  • Hôpital Saint Joseph, Marseille, France.
  • Heart Centre at the Alfred Hospital and Cabrini Hospital, Melbourne, Australia.
  • The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
  • Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
  • Mayo Clinic, Rochester, MN, USA.
  • Leiden University Medical Center, Willem Einthoven Institute for Arrhythmia Research and Management, Leiden, The Netherlands.
  • Hospital Ramón y Cajal, Madrid, Spain.
  • Clínica Universitaria de Navarra, Pamplona, Spain.
  • Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
  • Department of Cardiology, Kepler University Hospital Linz, Linz, Austria.
  • Hôpital Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France.
  • Sana Kliniken, Lübeck, Germany.
  • University Medical Centre, Ljubljana, Slovenia.
  • Cardiologie, EA7460 PEC2 UFR Sciences de Santé, Université Bourgogne Europe, CHU Dijon, Bourgogne, Dijon, France.
  • Helsinki University Hospital, Helsinki, Finland.
  • Hospital HM Madrid Montepríncipe, Madrid, Spain.
  • Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
  • University Hospital Basel, Basel, Switzerland.
  • Alfried Krupp Krankenhaus, Essen, Germany.
  • Witten/Herdecke University, Witten, Germany.
  • Department of Cardiology, Hacettepe University, Ankara, Türkiye.
  • Korea University College of Medicine and Korea University Anam Hospital, Seoul, South Korea.
  • Texas Cardiac Arrhythmia Institute, Austin and University of Tor Vergata, USA.
  • Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Heart Rhythm Research Brussels, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
  • Yonsei University College of Medicine, Seoul, Korea.
  • Institute for Clinical and Experimental Medicine, Prague, Czechia.
  • Copenhagen University Hospital Gentofte, Denmark.
  • Yuksek Ihtisas Cardiovascular Building, Ankara City Hospital, Ankara, Turkey.
  • Department of Cardiology, CHRU-Nantes, Université de Nantes, Nantes, France.
  • Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
  • Fundación Favaloro, Buenos Aires, Argentina.
  • Second Arrhythmia Department National Institute of Cardiology, Warsaw, Poland.
  • Almazov National Medical Research Center, St. Petersburg, Russia.
  • Center Hospitlaier Universitaire La Timone, Hôpitaux de Marseille, Marseille, France.
  • Southlake Health, Newmarket, Ontario, Canada.
  • Nippon Medical School, Tokyo, Japan.
  • Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
  • College of Medicine, Seoul National University Seoul, Korea.
  • Institutue for Cardiovascular Diseases, Dedinje, Belgrade, Serbia.
  • Hospital Universitário de Santa Maria, ULSSM, Lisbon, Portugal.

Abstract

BACKGROUND AND AIMS

Stroke and systemic embolism are recognized but poorly characterized complications of atrial fibrillation (AF) and left atrial flutter (AFL) catheter ablation. Their incidence, outcomes, and procedural associations remain insufficiently defined.

METHODS

Retrospective global registry was initiated by the European Heart Rhythm Association Scientific Committee. A secure database captured data from ablation centres worldwide on general AF and left AFL ablation activity, as well as detailed information on patients with symptomatic embolic events between 2017 and 2024.

RESULTS

Overall, 204 centres reported 335 743 ablation procedures and 550 embolic events (incidence 0.16%). Centre-level rate ranged from 0% to 3.1%. Most events were cerebral (94%), followed by peripheral (5%), and combined (1%). Coronary air embolism accounted for 62% of all peripheral events. Intraprocedural events occurred in 93 patients (17%), within 72 h in 357 (78%) and beyond 72 h in 100 (22%); 128 cases (23%) were diagnosed after hospital discharge. Nonparoxysmal AF (0.23% vs 0.15%; P < .001), centre experience, and ablation energy source (radiofrequency, 0.16%; cryoballoon, 0.16%; pulsed field ablation, 0.25%; laserballoon, 0.88%; P < .001) were associated with embolic risk. Median NIHSS score after stroke was 4 (interquartile range, 2-9). Three-month follow-up was available for 518 patients with embolism (95%): 181 (35%) had sequelae and 16 (3%) died.

CONCLUSIONS

Symptomatic embolic events are infrequent but associated with significant morbidity and mortality. Most events occur early, though a substantial proportion arise later. Higher event rates were observed with laser and possibly with pulsed field ablation. A greater centre experience was associated with a lower embolism incidence.

MeSH

Registries, Embolism, Stroke, Incidence, Atrial Fibrillation, Cardiology, Lasers, Pulsed Field Ablation