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