Citations 2
Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry
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European Heart Journal | March 31, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
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.
Outcomes of Early Rhythm Control Therapy in Patients With Atrial Fibrillation and a High Comorbidity Burden in Large Real-World Cohorts
Dickow, Jannis , Kany, Shinwan , Cardoso, Victor Roth , Gkoutos, Georgios V. , Houten, Holly K. Van , Kirchhof, Paulus , Metzner, Andreas , Noseworthy, Peter A. , Yao, Xiaoxi , Rillig, Andreas , Roth Cardoso, Victor , Ellinor, Patrick T , Gkoutos, Georgios V , Van Houten, Holly K , Kirchhof, Paulus , Noseworthy, Peter A , Yao, Xiaoxi , Rillig, Andreas , Ellinor, Patrick T.
Circulation: Arrhythmia and Electrophysiology | March 21, 2023 | Volume: 16 | Issue: 5 | Pages: No page available
Background: A recent subanalysis of the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) suggests a stronger benefit of early rhythm control (ERC) in patients with atrial fibrillation and a high comorbidity burden when compared to patients with a lower comorbidity burden. Methods: We identified 109 739 patients with newly diagnosed atrial fibrillation in a large United States deidentified administrative claims database (OptumLabs) and 11 625 patients in the population-based UKB (UK Biobank). ERC was defined as atrial fibrillation ablation or antiarrhythmic drug therapy within the first year after atrial fibrillation diagnosis. Patients were classified as (1) ERC and high comorbidity burden (CHA 2 DS 2 -VASc score ≥4); (2) ERC and lower comorbidity burden (CHA 2 DS 2 -VASc score 2–3); (3) no ERC and high comorbidity burden; and (4) no ERC and lower comorbidity burden. Patients without an elevated comorbidity burden (CHA 2 DS 2 -VASc score 0–1) were excluded. Propensity score overlap weighting and cox proportional hazards regression were used to balance patients and compare groups for the primary composite outcome of all-cause mortality, stroke, or hospitalization with the diagnoses heart failure or myocardial infarction as well as for a primary composite safety outcome of death, stroke, and serious adverse events related to ERC. Results: In both cohorts, ERC was associated with a reduced risk for the primary composite outcome in patients with a high comorbidity burden (OptumLabs: hazard ratio, 0.83 [95% CI 0.72–0.95]; P =0.006; UKB: hazard ratio, 0.77 [95% CI, 0.63–0.94]; P =0.009). In patients with a lower comorbidity burden, the difference in outcomes was not significant (OptumLabs: hazard ratio, 0.92 [95% CI, 0.54–1.57]; P =0.767; UKB: hazard ratio, 0.94 [95% CI, 0.83–1.06]; P =0.310). The comorbidity burden interacted with ERC in the UKB (interaction- P =0.027) but not in OptumLabs (interaction- P =0.720). ERC was not associated with an increased risk for the primary safety outcome. Conclusions: ERC is safe and may be more favorable in a population-based sample of patients with high a comorbidity burden (CHA 2 DS 2 -VASc score ≥4).