Citations 2
Undetected Heart Failure in Cardiology: Prevalence, Characteristics, and Outcome
Chollet, Laurève , Rumora, Klara, Durak, Koray , Strebel, Ivo , Huré, Gabrielle , Wussler, Desirée , Belkin, Maria , López‐Ayala, Pedro , Gualandro, Danielle M, Kaplan, Emel, Good, Manuel, Leibundgut, Gregor , Frey, Simon, Zellweger, Michael J. , Müller, Christian , Haaf, Philip , Kühne, Michael , Sticherling, Christian , Mahfoud, Felix , Pfister, Otmar , Zellweger, Michael J , Mueller, Christian , Gualandro, Danielle Menosi , Kaplan, Emel , Frey, Simon , Haaf, Philip
European Journal of Preventive Cardiology | August 17, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Aim To confirm or refute recent pilot studies showing unexpectedly high rates of undetected heart failure (HF) in cardiology patients. Methods We assessed the prevalence, characteristics, and outcome of undetected HF in a large prospective cohort study of patients referred for non-invasive coronary artery disease (CAD) work-up with cardiac positron emission tomography computed tomography. HF presence and phenotype were centrally adjudicated by an independent cardiologist according to clinical practice guidelines requiring three mandatory criteria: symptoms, elevated natriuretic peptides, and structural/functional cardiac abnormalities. The endpoint was a composite of cardiovascular death and acute HF (AHF) hospitalization through 2-year of follow-up. Results Among 1738 eligible patients (median age 67 years, 30% women), 138 patients (7.9%) had known HF, and 534 of 1600 patients (33.4%) without known HF had adjudicated undetected HF, resulting in a ratio of undetected HF to known HF of 3.9 (95%CI, 3.2–4.7)-to-1 and a number needed to screen to detect one patient with undetected HF of 3.0 (95%CI, 2.9-3.1). In undetected HF, left ventricular ejection fraction (LVEF) was preserved in 72.3%, mildly reduced in 16%, and reduced in 11.7%. Older age, known CAD, atrial fibrillation, previous pacemaker implantation, and ECG abnormalities were associated with a higher likelihood for undetected HF. Undetected HF was associated with an increased cumulative incidence of the composite endpoint (adjusted subdistribution hazard ratio 7.37 [95%CI, 3.87-14.06], p<0.001, versus no HF). Conclusion One-out-of three patients referred for CAD work-up had undetected HF, which was associated with cardiovascular death and AHF hospitalization.
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.