Stroke and Embolism After Ablation for AF Patients

TOPLINE:

Although catheter ablation for atrial fibrillation reduced long-term thromboembolic risk, it carried a rare but potentially devastating risk for stroke and systemic embolism, which may lead to substantial sequelae or death.

METHODOLOGY:

Drawing from a global, retrospective registry, researchers assessed outcomes after catheter ablation for atrial fibrillation and left atrial flutter, focusing on the incidence of stroke and systemic embolism.
The registry included 335,743 ablation procedures from 204 centers across 56 countries between 2017 and 2024. Of those, 547 patients experienced stroke and systemic embolism. The median age of patients was 66, and 62% were men.
Stroke and systemic embolism were defined as the occurrence of stroke, transient ischemic attack, or other symptomatic peripheral embolism temporally associated with catheter ablation for atrial fibrillation or left atrial flutter, identified during the procedure or within 30 days after ablation.

TAKEAWAY:

A total of 550 events of stroke and systemic embolism were reported, corresponding to an overall risk of 0.16% (95% CI, 0.15-0.18); most events occurred within 72 hours of ablation, but nearly a quarter of them were diagnosed after discharge.
Among patients who experienced stroke and systemic embolism after ablation, 93% received anticoagulation therapy before the procedure; of these, 86% underwent ablation with uninterrupted or minimally interrupted therapy.
The risk for stroke and systemic embolism was 60% higher with ablation for persistent vs paroxysmal atrial fibrillation (95% CI, 1.3-1.9); the risk was also higher with first-time ablation than with repeat ablation (95% CI, 1.2-2.0). Pulsed field ablation showed a similar 60% higher risk than radiofrequency (95% CI, 1.1-2.1) and cryoballoon ablation (95% CI, 1.1-2.3).
At 3 months, 35% of the patients who experienced stroke and systemic embolism had unequivocally diagnosed sequelae and 3% died. Among patients who had a stroke, 8% were disabled and 4% died.

IN PRACTICE:

“Our findings emphasize the importance of strict periprocedural anticoagulation, careful attention to sheath and catheter exchanges, and systematic monitoring after hospital discharge, as nearly one quarter of events occurred after hospitalization,” the researchers wrote.

SOURCE:

The study was led by Sergio Castrejón-Castrejón, La Paz University Hospital, Madrid, Spain, and Christian-Hendrik Heeger, Klinik für Kardiologie und Innere Medizin, Asklepios Klinik Hamburg Altona, Hamburg, Germany. It was published online on March 31 in the European Heart Journal.

LIMITATIONS:

Because the study used a retrospective registry, chances of underreporting, particularly events that were transient or minor, could not be ruled out. The retrospective periods varied across the participating centers. Additionally, variables with missing data were excluded if they exceeded a predefined 10% threshold or lacked clinical relevance. Furthermore, advanced methods for handling missing data were not applied.

DISCLOSURES:

No funding information was declared. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.