Arrhythmias & electrophysiologyCohort study
Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry
- Retrospective registry study
- global
- multicentre
Authors' conclusion
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.
Study context
- Population
- Patients undergoing atrial fibrillation (AF) and left atrial flutter catheter ablation, ablation centres worldwide, 2017–2024
- Participants
- 335,743 ablation procedures
- Outcome
- Symptomatic embolic events (stroke and systemic embolism) after ablation: incidence
Main finding
As reported in the abstract
Symptomatic embolic events
- Embolic events
- 550
- Incidence
- 0.16%
- Centre-level rate
- 0% to 3.1%
- Cerebral
- 94%
- Peripheral
- 5%
- Combined
- 1%
- Coronary air embolism, of peripheral events
- 62%
Observational data: associations, not effects.
Further findings
| Outcome | Values | P value |
|---|---|---|
| Embolic risk by AF type | Nonparoxysmal AF 0.23% · Paroxysmal AF 0.15% | P < 0.001 |
| Embolic risk by ablation energy source | Radiofrequency 0.16% · Cryoballoon 0.16% · Pulsed field ablation 0.25% · Laserballoon 0.88% | |
| NIHSS score after stroke | Stroke median 4 (IQR 2–9) |
- Embolic risk by ablation energy source: P < .001
Timing of embolic events
- Intraprocedural
- 93 (17%)
- Within 72 h
- 357 (78%)
- Beyond 72 h
- 100 (22%)
- Diagnosed after hospital discharge
- 128 (23%)
Centre experience
- Centre experience associated with embolic risk
Outcomes after embolism · 3 months
- Follow-up available
- 518 (95%)
- Sequelae
- 181 (35%)
- Died
- 16 (3%)
Original publication
Stroke and systemic embolism following atrial fibrillation ablation: the EMBOL-AF Global Registry. Eur Heart J. Published 31 March 2026. doi:10.1093/eurheartj/ehag217
Summarised from the published abstract; every number is checked against it