Citations 2
Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials
Karakasis, Paschalis , Vlachos, Konstantinos , Siontis, Konstantinos C. , Cano, Óscar , Tzeis, Stylianos , Strik, Marc , Pamporis, Konstantinos , Leventopoulos, Georgios , Antoniadis, Antonios P. , Jaı̈s, Pierre , Burri, Haran , Fragakis, Nikolaos , Karakasis, Paschalis , Pamporis, Konstantinos , Antoniadis, Antonios P , Jaïs, Pierre , Burri, Haran
Europace | July 1, 2026 | Volume: 28 | Issue: 8 | Pages: No page available
Abstract Aims Conduction system pacing (CSP) has emerged as a physiologic alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP) in heart failure with reduced ejection fraction (HFrEF), yet its comparative effects remain uncertain. This meta-analysis sought to compare outcomes of CSP vs. BiVP in patients with HFrEF undergoing CRT. Methods and results MEDLINE, Embase, Scopus, and the Cochrane Database were searched through 4 May 2026. Randomized controlled trials (RCTs) were synthesized using random-effects meta-analysis. Thirteen RCTs including 1320 participants were analysed (657 CSP, 663 BiVP). Conduction system pacing was associated with a lower risk of the composite of hospitalization for heart failure (HHF) or all-cause mortality compared with BiVP (46 vs. 83 events; odds ratio [OR] 0.51, 95% confidence interval [CI] 0.28–0.93). No significant differences were observed for HHF alone (OR 0.68, 95% CI 0.36–1.27) or all-cause mortality (OR 0.75, 95% CI 0.36–1.58). Conduction system pacing was associated with greater improvement in the 6-min walk distance (mean difference [MD] 21.53 m, 95% CI 4.33–38.73) and New York Heart Association functional class (standardized mean difference [SMD] −0.27, 95% CI −0.47 to −0.07), but not quality of life. Conduction system pacing also reduced QRS duration compared with BiVP (MD −10.94 ms, 95% CI −17.55 to −4.34), with no significant differences in left ventricular ejection fraction, left ventricular end-systolic volume, overall pacing threshold, total procedure time, fluoroscopy time, any complication, or reintervention. Conclusion In patients with HFrEF undergoing CRT, CSP is associated with lower composite risk of HHF or all-cause mortality compared with BiVP. Conduction system pacing is also associated with improved functional capacity, without significant differences in safety or procedural outcomes.
Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry
Castrejón-Castrejón, Sergio , Heeger, Christian-Hendrik H., Veltmann, Christian, Schaack, David , Nies, Moritz , Gunawardene, Melanie , Steven, Daniel , Tscholl, Verena , Roten, Laurent, Sommer, Philipp, Spartalis, Michael , Seitz, Julien , Kistler, Peter M, Chen, Minglong, Wang, Q , Munoz, Freddy Del-Carpio, Wijnmaalen, Adrianus P. , Moreno, Javier , Albarrán-Rincón, Ramón, Sanders, Prashanthan, Blessberger, Hermann , Laredo, Mikaël, Krahnefeld, Olaf , Pernat, Andrej , Aro, Aapo L. , Martinez, Eduardo Castellanos, Scazzuso, Fernando , Neven, Kars , Yorgun, Hikmet , Natale, Andrea, Joung, Boyoung, Wichterle, Dan, Cay, Serkan, Andorin, Antoine , Kato, Hiroyuki, Carnero, Guillermo, Maciąg, Aleksander, Garkina, S. V. , Deharo, Jean-Claude, Sadek, Mouhannad M, Iwasaki, Yu-ki, Beiert, Thomas , Choi, Eue-Keun, Kojic, D, Bergau, Leonard, Lellouche, N, Cortés, Luis Arabia, Camargo, Juan Manuel, Inaba, Osamu, Szegedi, Nándor , Piccini, Jonathan P., Marijon, Eloi, Mazurek, M , Sandgaard, Niels C F, Francke, Alexander , Schumacher, Burghard, Sánchez, Christian David Adams, Garcia-Izquierdo, E G I Eusebio, Guerra, Jose M., Aboulmaaty, Mervat , Jansen, Henning , Metzner, Andreas , García, Cecilia Zapata , Chun, J. K. R., Merino, José L, investigators, The EMBOL-AF, Benkouar, Riad, Abello, Maurício, Aguinaga, Luis, Correa, Mariel Alvarez , Estrada, Alejandro , Figueroa, Jorge, López, Leonardo Guido, Mondragón, Ignacio, Hovakimyan, Tatevik , Kalman, Jonathan, Maisels, Leonid, Kistler, Bruno Scardamaglia, Crowley, Rose , Steinwender, Clemens , Kousta, Mary, Scherr, Daniel, Goelly, Katharina Ingrid, Rocca, Domenico Giovanni Della, Potter, Tom J R De, Boškić, Mario, D’Avila, Andre, Guimarães, Henrique Cerqueira , Slater, Charles , Saad, Eduardo, Marchov, D. , Ayala-Paredes, Félix Alejandro, Glover, Benedict, Khaykin, Yaariv, Silva, Armando Pérez, Salvatici, Luis Quiñiñir, Li, Mingfang, Yao, Yan, Zhou, Li , Yi, Fu, Zeng, Rui, Molano, Luis Fernando Pava, Velasco, Víctor Manuel, Ramírez, Santiago Giraldo , Morales, Luis Carlos Saenz, Radeljić, Vjekoslav , Larsen, Jacob Moesgaard, Jacobsen, Peter Karl, Liñero, Mikel, Patete, Manuel , Hallon, Luis, Rivadeneira, José Llorente, Moustafa, Ahmed, Botros, Michael Sobhy, Minois, Damien , Anselme, Frédéric, Bakouboula, Babé, Schaaf, Mathieu , Boveda, Serge, Richard-Vitton, Robin, Détis, Nicolas, Fauchier, Laurent, Pierre, Bertrand , García, Rodrigue, Degand, Bruno , Salaün, Alexandre, Gandjbakhch, Estelle, Martins, Raphael, Maury, Philippe, Milhem, Antoine , Arnaout, Alain Al, Pavin, Dominique , Piot, Olivier, Ballatore, Andrea, Zhao, Alexandre , Papiashvili, Giorgi , Rekvava, Roin , Avranas, Konstantinos, Eckardt, Lars, Forkmann, Mathias , Busch, Sonia, Harloff, Tim, Halbfass, Philipp, Hilss, Karen Anja, Kaufmann, Jan , Thilotray, Christian, Poley, Phillip, Küchler, Mirco , Tilz, Roland Richard, Maslova, Vera , Lian, Evgeny, Füting, Anna , Letsas, Konstantinos P., Papakonstatinou, Panteleimon, Tzeis, Stylianos, Geller, Laszlo, Narasimhan, Calambur, Koduri, Venkata Krishna Chaitanya, Ghosh, Anindya, Lubis, Anggia Chairuddin , Emkanjoo, Zahra , Eslami, Masoud, Conti, Sergio, Perrotta, Laura , Pieragnoli, Paolo , Poggi, Sara, Ruggiero, Donatella, Aurino, L, Russo, Vicenzo, Hashiguchi, Naotaka , SHIMIZU, Wataru, Yodogawa, Kenji , Suga, Kazumasa , Yamaguchi, Takanori, Bakytzhanuly, Abay, Dussekeyeva, Gulnoza, Dehkhanova, Shakhnoza, Kupics, Kaspars, Jubele, Kristine, Refaat, Marwan M, Ghazawi, Alaaeddine El, Sammut, Mark A, Márquez-Murillo, Manlio F., Rogel-Martínez, Ulises, Nolasco, Karla Bozada, Khurelbaatar, Mungun-Ulzii, Dagdan, Batnaran, Kooijman, Edwin, Martin, Andrew, Kiliszek, Marek, Kulakowski, Piotr, Żuk, Anna , Lebreiro, Ana , Diaz, Nuno Cortez, Cozma, Dragos, Grecu, Mihaela, Rudzik, Roxana, Sipos, Sergiu, Vatasescu, Radu, Lebedev, Dmitry, Lee, So-Ryoung, Kim, Daehoon, Luque, Miguel Amores , Arenal, Ángel, Alonso, Pablo Ávila , Sanchez, Antonio Berruezo, Cabanas-Grandío, Pilar, Cózar-León, Rocío, Díaz-Infante, Ernesto, Fernández-Armenta, Juan, Fernández-Gómez, Juan Manuel, Jaén, Eusebio García-Izquierdo , García-Olea, Alain, Gaztañaga, Larraitz , Guasch, E, Criado, José Luis Ibáñez, Garrido, Beatriz Jáuregui, Sierra, Cristina Martin, Osca, Joaquin, Castellano, Nicasio Pérez, Ocete, Blanca Quesada, Rivas-Gándara, Nuria, Rubio-Campal, José Manuel, Brotons, J.A. Sánchez, Sánchez-Somonte, Paula, Segura, Jose Maria, Segura-Villalobos, Federico, Hernández, Pablo Ruiz, Soria, Laura Valverde , Fengsrud, Espen, Reichlin, Tobias, Krisai, Philipp, Tramèr, Lucas, Ngarmukos, Tachapong , Trines, Serge A., Mulder, Bart A. , İhtisas, Yüksek, Yilancioğlu, Yiğit, Şahin, Durmuş Yıldıray , Yalin, Kivanc, Yalman, Hakan , Aytemir, Kudret, Martin, Claire A , Zeriouh, Sarah , Abbas, Mohamed Magdi, Chamoun, Nadia , Bsoul, Mayana, Mohanty, Sanghamitra, Uzokov, Jamol, Benchetrit, Chamia, Choi, Jong‐Il , Joung, Boyoung , Roten, Laurent , Del-Carpio Munoz, Freddy , Sanders, Prashanthan , Sticherling, Christian , Joung, Boyoung , Wichterle, Dan , Cay, Serkan , Kato, Hiroyuki , Deharo, Jean Claude , Choi, Eue-Keun , Bergau, Leonard , Lellouche, Nicolas , Marijon, Eloi , Ramos Jiménez, Javier , Metzner, Andreas , Pürerfellner, Helmut , Merino, Jose L , Heeger, Christian-Hendrik H. , Veltmann, Christian , Sommer, Philipp , Kistler, Peter M. , Chen, Ming-Long , Munoz, Freddy Del‐Carpio , Albarrán‐Rincón, Ramón , Sanders, Prashanthan , Laredo, Mikael , Guénancia, Charles , Natale, Andrea , Almorad, Alexandre , Ruwald, Martin H , Carnero, Guillermo A. , Deharo, Jean‐Claude , Sadek, Mouhannad M. , Iwasaki, Yu‐ki , Choi, Eue‐Keun , Kojić, Dejan , Sousa, João de , Bergau, Leonard , Inaba, Osamu , Piccini, Jonathan P. , Marijon, Éloi , Sandgaard, Niels C. 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.