Citations 2
Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry
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F. , Stiles, Martin K. , García‐Izquierdo, Eusebio, Ares, Gerardo Ruiz , Aguinaga, Luis, Munawar, Dian Andina , Puvrez, Alexis , Gölly, Katharina Ingrid , Rocca, Domenico G. Della , Begić, Edin , d'Avila, Andre, Guimaraes, Henrique, Saad, Eduardo , Dzhinsov, Krasimir R. , TRAYKOV, VASSIL BORISLAVOV , Paredes, Felix Ayala , Glover, Benedict , Macle, Laurent , Khaykin, Yaariv , Pérez-Silva, Armando , Díaz, Juan Carlos , Giraldo-Ramírez, Santiago, Morales, Luis C. Sàenz, Đula, Kristijan , Peichl, Petr , Larsen, Jacob Moesgaard , Jacobsen, Peter Karl , Hallon, Luis A., Rivadeneira, José Elizardo Llorente , Botros, Michael, Anselme, Frédéric , Chaumont, Corentin , Bakouboula, Babé , Bovéda, Serge , Richard-Vitton, Robin , Boulé, Stéphane , Fauchier, Laurent , Garcia, Rodrigue , Salaun, Alexandre, Gandjbakhch, Estelle , Martins, Raphaël P. , Maury, Philippe , Beneyto, Maxime M , Piot, Olivier , Ballatore, Andrea , Asbach, Stefan , Avranas, Konstantinos, Didenko, Maxim , Eckardt, Lars , Harloff, Tim , Halbfaß, Philipp , Tilz, Roland Richard , Lian, Evgeny, Sohns, Christian , Lüker, Jakob , Zabel, Markus , Letsas, Κonstantinos P. , Leventopoulos, Georgios , Tzeis, Stylianos , Kupó, Péter , Geller, Laszlo A. , Narasimhan, Calambur, Pandurangi, Ulhas M. , Ghosh, Anindya , Haim, Moti , Konstantino, Yuval , Barletta, Valentina , Cipolletta, Laura , Conti, Sergio , Sgarito, Giuseppe A. , Poggi, Sara , Ruggiero, Donatella , Ejima, Koichiro , Shimizu, Wataru, Kato, Hiroyuki, Abdrakhmanov, Ayan Suleimenovich , Bakytzhanuly, A, Kupics, Kaspars , Jubele, Kristīne , Refaat, Marwan M., Ghazawi, Alaaeddine El , Sammut, Mark Adrian , Rojel-Martínez, Ulises, Bozada-Nolasco, Karla I., Denysiuk, Piotr , Farkowski, Michał M. , Futyma, Piotr , Zarębski, Łukasz , Kiliszek, Marek , Kulakowski, Piotr , Lenarczyk, Radosław , Miśkowiec, Dawid Łukasz , Sousa, Pedro , Grecu, Mihaela, Arenal, Ángel , Cabanas‐Grandío, Pilar , León, Rocío Cózar , Dı́az-Infante, Ernesto , Fernandez-Armenta, Juan, Olea, Alain García, Guasch, Eduard , Ibáñez, José Luis , Garrido, Beatriz Jáuregui, Osca, Joaquín , Rivas‐Gándara, Nuria , Campal, J M Rubio, Sánchez-Somonte, Paula , Segura, José María, Fengsrud, Espen , Bergonti, Marco , Reichlin, Tobias , Krisai, Philipp , Tramèr, Lucas , Trines, Serge A.I.P. , Özkan, Eyüp , Özcan, Emin Evren , Yılancıoğlu, Yiğit, Yalın, Kıvanç , Aytemir, Kudret , Abbas, Mohamed Magdy, Akoum, Nazem , Bsoul, Mayana , Mohanty, Sanghamitra
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.
Recent-onset atrial fibrillation: challenges and opportunities
Svennberg, Emma , Andrade, Jason G. , Anselmino, Matteo , Biton, Yitschak , Brandes, Axel , Buckley, Claire , Espuny, Josep Lluis Clua , Doehner, Wolfram , Domínguez, Helena , Fauchier, Laurent , Glotzer, Taya V. , Hendriks, Jeroen , Hills, Mellanie True , Hindricks, Gerhard , Joung, Boyoung , Levin, Lars‐Åke , Liu, Shaowen , Lobban, Trudie , Macfarlane, Peter W. , Mairesse, Georges H. , Marcus, Gregory M. , Orchard, J. , Reiffel, James A. , Siontis, Konstantinos C. , Stavrakis, Stavros , Svendsen, Jesper Hastrup , Teh, A. , Tieleman, Robert G , Camm, A. John , Freedman, Ben , Andrade, Jason G , Anselmino, Matteo , Biton, Yitschak , Boriani, Giuseppe , Brandes, Axel , Buckley, Claire , Cameron, Alan C , Lluis Clua Espuny, Josep , Crijns, Harry J G M , Diederichsen, Søren Z , Doehner, Wolfram , Dominguez, Helena , Duncker, David , Fauchier, Laurent , Glotzer, Taya , Guo, Yutao , Haeusler, Karl G , Haim, Moti , Healey, Jeffrey S , Hendriks, Jeroen M , True Hills, Mellanie , Hindricks, Gerhard , Hobbs, F D Richard , Johnson, Linda S B , Joung, Boyoung , Kamel, Hooman , Kirchhof, Paulus , Lane, Deirdre A , Levin, Lars-Åke , Lip, Gregory Y H , Liu, Shaowen , Lobban, Trudie , Macfarlane, Peter W , Mairesse, Georges , Marcus, Gregory M , Noseworthy, Peter A , Ntaios, George , Orchard, Jessica J , Passman, Rod , Reidpath, Daniel D , Reiffel, James A , Ribeiro, Antonio Luiz , Rivard, Lena , Sanders, Prashanthan , Sandhu, Roopinder K , Schnabel, Renate B , Siontis, Konstantinos C , Sposato, Luciano A , Stavrakis, Stavros , Steinhubl, Steven , Svendsen, Jesper Hastrup , Teh, Andrew W , Themistoclakis, Sakis , Tieleman, Robert G , Camm, Alan John , Freedman, Ben , Boriani, Giuseppe , Cameron, Alan C. , Crijns, Harry J.G.M. , Diederichsen, Søren Zöga , Duncker, David , Haim, Moti , Healey, Jeff S. , Hobbs, Richard , Johnson, Linda S.B. , Kamel, Hooman , Kirchhof, Paulus , Lane, Deirdre A. , Noseworthy, Peter A. , Passman, Rod , Rivard, Léna , Sanders, Prashanthan , Schnabel, Renate B. , Sposato, Luciano A. , Tieleman, RG
European Heart Journal | June 23, 2025 | Volume: 47 | Issue: 2 | Pages: 170-187
Abstract Atrial fibrillation (AF) is increasingly diagnosed early, close to its first occurrence due to: (i) increased public awareness with self-screening; (ii) health care initiatives including population screening and opportunistic case finding; and (iii) increased use and surveillance of implantable cardiac devices. At its onset, AF is often low burden, and cardiovascular co-morbidities may be absent or at an early stage. Thus, the management of recent-onset AF has become an issue of growing importance. Professional guidelines have traditionally focused on anticoagulant thromboprophylaxis, generally recommending a cautious approach to rhythm control, and priority has been given to rate control to alleviate symptoms. In recent guidelines, the importance of managing lifestyle and co-morbidities has increased. The AF-SCREEN collaboration proposes that a vigorous approach to active management of recent-onset AF may be warranted. This includes addressing co-morbidities and promoting healthy lifestyles to prevent the emergence or progression of AF and associated cardiovascular disease, as well as the initiation of active rhythm control ± anticoagulation to prevent AF-related morbidity and mortality, including stroke and heart failure (HF). Intuitively, intervention early after AF onset would be beneficial since lifestyle and co-morbidity management, plus rhythm control and anticoagulation, are important contributors to improved outcomes in patients with established AF, but robust evidence is lacking for recent-onset AF. There is a delicate balance between achieving favourable outcomes such as preventing strokes, HF and AF progression vs the complications and potential adverse effects of interventions. Given the serious long-term consequences, innovative approaches are necessary to determine the value and risks of initiating active therapy very early in the course of AF. More data are needed to guide the best management of recent-onset AF, bearing AF burden in mind. Long-term studies using large national databases linked to electronic medical records and rhythm monitoring devices offer excellent opportunities. Shorter-term studies focusing on reducing AF burden to slow AF progression and studies focusing on outcomes such as HF could be used in both randomized clinical trials and observational cohort studies.