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.

Authors

Publication Details

Journal
Open Access CRIS of the University of Bern
Published
2026-03-31
DOI
https://doi.org/10.48620/97534
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

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

Martin K. Stiles, Verena Tscholl, Mervat Aboulmaaty, Olaf Krahnefeld et al.
Open Access CRIS of the University of Bern
Atrial Fibrillation Management and Outcomes
article

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

Martin K. Stiles, Verena Tscholl, Mervat Aboulmaaty, Olaf Krahnefeld, Henning Jansen, David Schaack, Moritz Nies, Juan Manuel Camargo, Martin Huth Ruwald, Thomas Beiert, Julien Seitz, Christian-Hendrik H. Heeger, Nándor Szegedi, Antoine Andorin, Andrej Pernat, Alexandre Almorad, Aapo Aro, Burghard Schumacher, Aleksander Maciąg, Javier Ramos Jiménez, Niels C F Sandgaard, Ramón Albarrán-Rincón, Melanie Gunawardene, Kars Neven, Eue-Keun Choi, Cecilia Zapata García, Alexander Francke, Eloi Marijon, João Sousa, Eusebio García-Izquierdo, Osamu Inaba, Jong-Il Choi, Yu-Ki Iwasaki, Javier Moreno, Boyoung Joung, Svetlana Garkina, Charles Guenancia, Helmut Pürerfellner, Hermann Blessberger, Michael Spartalis, Julian Kyoung-Ryul Chun, Christian David Adams Sánchez, Peter M Kistler, Dejan Kojic, Serkan Cay, Freddy Del-Carpio Munoz, Jean-Claude Deharo, Laurent Roten, Nicolas Lellouche, Leonard Bergau, José L Merino, Prashanthan Sanders, Dan Wichterle, Minglong Chen, Andrea Natale, Gerardo Ruiz Ares, Christian Veltmann, Fernando Scazzuso, Luis Arabia Cortés, Qunshan Wang, Daniel Steven, Mouhannad M Sadek, Jonathan P Piccini, Guillermo Carnero, Philipp Sommer, Adrianus P Wijnmaalen, Mikaël Laredo, Jose M Guerra, Sergio Castrejón-Castrejón, Hikmet Yorgun, Eduardo Castellanos Martínez, Michal Mazurek, Andreas Metzner, Christian Sticherling, Hiroyuki Kato
article en

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.

Open Access CRIS of the University of Bern
Good health and well-being
Openalex Percentile: Top 5%
Atrial Fibrillation Management and Outcomes
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.