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