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

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.

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Journal
European Heart Journal
Published
2026-03-31
DOI
https://doi.org/10.1093/eurheartj/ehag217
Citations
1
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
19.37
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article

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

Martin K. Stiles, Q Wang, Helmut Pürerfellner, Ignacio Mondragón et al.
1 citations
European Heart Journal
Atrial Fibrillation Management and Outcomes
19.37
article

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

Martin K. Stiles, Q Wang, Helmut Pürerfellner, Ignacio Mondragón, Charles Guénancia, Verena Tscholl, Alexis Puvrez, Riad Benkouar, Eduardo Castellanos Martinez, Mervat Aboulmaaty, Hikmet Yorgun, Olaf Krahnefeld, Henning Jansen, Kars Neven, Christian-Hendrik H. Heeger, David Schaack, Aapo L. Aro, Moritz Nies, Jorge Figueroa, D. Munawar, Juan Manuel Camargo, Gerardo Ruiz‐Ares, Martin Huth Ruwald, Thomas Beiert, Julien Seitz, Melanie Gunawardene, Clemens Steinwender, Fernando Scazzuso, J. K. R. Chun, Nándor Szegedi, Andreas Metzner, Adrianus P. Wijnmaalen, João de Sousa, Cecilia Zapata García, Antoine Andorin, Andrej Pernat, Alexander Francke, N Lellouche, Christian Sticherling, Tatevik Hovakimyan, Alexandre Almorad, S. V. Garkina, Jong-Ιl Choi, Javier Ramos Jiménez, Rose Crowley, Maurício Abello, Prashanthan Sanders, Aleksander Maciąg, E G I Eusebio Garcia-Izquierdo, Mariel Alvarez Correa, Michael Spartalis, M Mazurek, D Kojic, Alejandro Estrada, Jose M. Guerra, Mikaël Laredo, Eue-Keun Choi, Jonathan Kalman, José L Merino, Mary Kousta, Hermann Blessberger, Niels C F Sandgaard, Peter M Kistler, Jonathan P. Piccini, Leonard Bergau, Luis Arabia Cortés, Serkan Cay, Freddy Del-Carpio Munoz, Yu-ki Iwasaki, Christian Veltmann, Dan Wichterle, Laurent Roten, The EMBOL-AF investigators, Luis Aguinaga, Eloi Marijon, Andrea Natale, Sergio Castrejón-Castrejón, Christian David Adams Sánchez, Osamu Inaba, Javier Moreno, Minglong Chen, Daniel Steven, Leonardo Guido López, Guillermo Carnero, Leonid Maisels, Bruno Scardamaglia Kistler, Jean-Claude Deharo, Hiroyuki Kato, Boyoung Joung, Mouhannad M Sadek, Philipp Sommer, Ramón Albarrán-Rincón
article en
1 citations

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.

European Heart Journal
Semmelweis University (HU), TH Köln - University of Applied Sciences (DE), University of Bern (CH), National University of Tucumán (AR), Heart Rhythm Society (US), Royal Adelaide Hospital (AU), Witten/Herdecke University (DE), Université de Bourgogne (FR), University of Bremen (DE), University of Cologne (DE), Favaloro University (AR), Yonsei University (KR), National and Kapodistrian University of Athens (GR), University Hospital Bonn (DE), Leiden University Medical Center (NL), Helsinki University Hospital (FI), Heart and Diabetes Center North Rhine-Westphalia (DE), Hospital Universitario La Paz (ES), University Hospital of Bern (CH), Ljubljana University Medical Centre (SI), XinHua Hospital (CN), Hospital de Sant Pau (ES), The Alfred Hospital (AU), Southlake Regional Health Center (CA), New Generation University College (ET), Copenhagen University Hospital (DK), Gentofte Hospital (DK), Federal Almazov North-West Medical Research Centre (RU), Centre Hospitalier Universitaire Henri-Mondor (FR), Humboldt-Universität zu Berlin (DE), Sorbonne Université (FR), Asklepios Klinik Altona (DE), Research Institute Hospital 12 de Octubre (ES), Türkiye Yüksek İhtisas Hastanesi (TR), Assistance Publique Hôpitaux de Marseille (FR), Cardiovascular Center Bethanien (DE), Hospital Universitário de Santa Maria (BR), Sana Kliniken Duisburg (DE), Westpfalz Klinikum (DE), Cabrini Hospital (AU), Hospital Base (CL), Fundación Valle del Lili (CO), Universitäres Kinderwunschzentrum Lübeck (DE), Hospital Universitario 12 De Octubre (ES), Helios Klinikum Krefeld (DE), Hospital La Paz Institute for Health Research (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Deutsches Herzzentrum der Charité (DE), Hôpital Saint Joseph (FR), Universitätsmedizin Göttingen (DE), Institute for Cardiovascular Diseases of Vojvodina (RS), Hospital Universitario HM Madrid (ES), Kepler Universitätsklinikum (AT), Pitié-Salpêtrière Hospital (FR), Asklepios Klinik St. Georg (DE), Fundacion Favaloro Hospital Universitario (AR), The Arrhythmia Institute (US), Mayo Clinic in Arizona (US), Duke Medical Center (US), Clinical Trials New Zealand (NZ), Universitair Ziekenhuis Brussel (BE), Institute of Clinical and Experimental Medicine (CZ), Centro Científico Tecnológico - Tucumán (AR), Krankenhaus der Elisabethinen (AT), Fundación Santa Fe de Bogotá (CO), Agaplesion Bethanien Krankenhaus (DE), Silesian Center for Heart Disease (PL), Clinica Universidad de Navarra (ES), Ohio Heart & Vascular Center (US), Yüksek İhtisas Üniversitesi (TR), European Hospital (IT), Texas Cardiac Arrhythmia (US), Chukyo Hospital (JP), Agaplesion Markus Hospital (DE), Saitama Red Cross Hospital (JP), Alfried Krupp Hospital (DE), National Heart Institute (EG), Klinikum Bremen-Mitte (DE), Favaloro Foundation (AR), Instituto Cardiovascular de Buenos Aires (AR), Korea University (JP), Hospital Universitario Ramón y Cajal (ES), Hôpital de la Timone (FR), University of Waikato (NZ), Hacettepe University (TR), University of Göttingen (DE), Charité - Universitätsmedizin Berlin (DE), Nippon Medical School (JP), Nanjing Medical University (CN), University of Lübeck (DE), Nantes Université (FR)
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Atrial Fibrillation Management and Outcomes
19.37
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