New Afib ablation technology may carry higher stroke risk, study finds

Patients treated with pulsed-field ablation (PFA) for atrial fibrillation (AF) had a stroke or TIA rate nearly five times higher than those receiving radiofrequency ablation (RFA), according to a new single-center observational study — though the overall risk remains low.

Stroke / TIA rate — PFA

0.47%

10 events among 2,144 patients

Stroke / TIA rate — RFA

0.10%

2 events among 2,077 patients

Researchers at Beth Israel Deaconess Medical Center in Boston analyzed more than 4,200 consecutive AF ablation procedures performed between 2022 and 2026. They presented their findings at the European Heart Rhythm Association (EHRA) Congress 2026 in Paris — where late-breaking science on ablation techniques for atrial fibrillation management was a major theme.

Pulsed-field ablation has rapidly grown in popularity over the past several years, largely because it uses irreversible electroporation — a non-thermal mechanism — and offers shorter procedure times with a reduced risk of serious complications like esophageal injury, phrenic nerve paralysis, and pulmonary vein stenosis. But the new data suggest a more nuanced picture may be emerging. For background on how pulmonary vein isolation (PVI) works as the cornerstone of AF ablation, the Cleveland Clinic provides a useful overview.

"As we continued to do more of the procedures, we started to understand that perhaps the safety profile was a little bit more nuanced," said lead researcher Dr. Enrico Ferro. His team noted observing a "shower of microbubbles" under intracardiac echocardiography (ICE) during PFA procedures — a finding that raised concern even when it didn't immediately translate into a neurological event.

Researchers were unable to pinpoint a single cause for the difference. Patient demographics, operator experience, and procedural workflow differences were all examined, but none fully explained the higher stroke signal. Possible mechanisms include microbubble formation, thrombus formation, and endothelial disruption during more extensive ablation of the posterior left atrial wall.

The study arrives amid a broader pattern of scrutiny. The NEMESIS-PFA registry previously reported higher rates of troponin leak, hemolysis, and renal dysfunction with PFA compared to RFA. And in early 2025, Johnson & Johnson temporarily paused U.S. rollout of its Varipulse PFA system after four neurovascular events were reported during an external evaluation — a rate of stroke and TIA around 3%, well above the expected 1% benchmark for this type of surgery.

Experts emphasize that perspective is important. The absolute event rates remain well below 0.5% in both groups — consistent with prior ablation studies. Still, commentators agree the signal warrants dedicated follow-up. "Every brain cell matters," said Dr. Wilber Su of Banner University Medical Center Phoenix, noting that silent cerebral emboli are an ongoing concern across PFA trials. A 2026 EHRA/HRS scientific statement on PFA likewise acknowledged the technology's distinct safety profile and the need for ongoing vigilance.

Next steps include a large US claims database study and a nationwide FDA-supported postmarket surveillance study focused on stroke risk associated with PFA. As Dr. Su put it: "The more experience we have with PFA, the more we can learn how to be safer with it."

References

1. Ferro EG. Comparative safety of PFA vs RFA for stroke events: insights from a high-volume US medical center. Presented at: EHRA 2026. April 12, 2026. Paris, France. Reported by TCTMD.
2. Lakkireddy D, et al. NEMESIS-PFA: investigating collateral tissue injury associated with pulsed field ablation. JACC Clin Electrophysiol. 2025.
3. Ha FJ, et al. Advent of pulsed field ablation for atrial fibrillation: state-of-the-art review. Rev Cardiovasc Med. 2025;26.
4. Kühne M, et al. Pulsed field ablation for the interventional treatment of atrial fibrillation: a scientific statement of EHRA, HRS, APHRS, LAHRS, and CHRS. EP Europace. 2026.
5. Sun M, et al. Pulsed field ablation for atrial fibrillation: clinical applications and research advances. Front Cardiovasc Med. 2025.
6. Johnson & Johnson MedTech. J&J pauses Varipulse PFA cases in US. MedTech Dive. January 8, 2025.
7. Cleveland Clinic. Pulmonary vein isolation (PVI) ablation. Cleveland Clinic Health Library.

New Evidence for Iliac Vein Stenting: The C-TRACT Trial

For years, clinicians have utilized iliac vein stenting to treat Postthrombotic Syndrome (PTS) based largely on clinical intuition. However, high-level evidence has been scarce—until now.

Data from the C-TRACT trial, recently published in the New England Journal of Medicine, provides the validation needed to refine our endovascular approach to obstructed iliac veins.

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Key Clinical Findings

The study randomized 225 patients with moderate-to-severe PTS to either endovascular therapy (stenting plus enhanced antithrombotics) or standard care. At 6 months, the interventional arm demonstrated:

• Symptom Reduction: Significantly improved scores on the Venous Clinical Severity Score (VCSS), showing a 2-point benefit over control (P = 0.001).

• Quality of Life: A robust 14.5-point increase in VEINES-QOL scores, indicating a meaningful impact on daily functionality.

• Device Performance: The benefits appear to be a class effect across approved venous stents, including Abre and Venovo.

The Trade-off: Bleeding Risk

The primary complication was a higher rate of bleeding events (11.6% vs. 3.6%; $P = 0.03$). These were predominantly nonmajor and likely linked to the intensified antithrombotic therapy required post-procedure, rather than the stenting procedure itself.

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Practice Implications

The C-TRACT results move the needle toward evidence-based intervention. However, success hinges on individualized care. Shared decision-making is essential to balance substantial quality-of-life gains against bleeding risks and the need for long-term surveillance.

Women are less likely to take heart medications after a cardiac event — and socioeconomics may be why

A new analysis of the TEXTMEDS trial reveals meaningful gaps in how men and women manage cardiovascular health after acute coronary syndromes.

After a heart attack or other acute coronary syndrome (ACS), sticking to medications is critical — but a new study shows women are doing so at notably lower rates than men. The finding, published in Open Heart, comes from a secondary analysis of TEXTMEDS, a randomized clinical trial that tested whether text-message reminders could improve medication adherence after ACS in Australian patients.

The numbers

Among 1,379 participants tracked for 12 months, just 46% of women reported taking all five recommended heart medications — compared to 54% of men. The gap held across a range of drugs, including statins, beta-blockers, aspirin, ACE inhibitors, and P2Y12 inhibitors.

Women fully adherent

46%

Men fully adherent

54%

Women reaching LDL target

39%

Women were also less likely to meet the recommended LDL-cholesterol target of under 70 mg/dL (39% vs. nearly 50% of men), and less likely to achieve regular physical activity goals (50% vs. 63%). On one measure, however, women came out ahead: they were more likely than men to maintain a healthy body mass index.

Socioeconomics as the hidden variable

One of the study's most important findings was what happened when researchers adjusted for socioeconomic factors like income and education: the adherence gap between men and women largely disappeared. The one exception was statins, where women remained significantly less likely to adhere even after full adjustment.

"When we accounted for socioeconomic factors like income and education, the difference between men and women largely disappeared, suggesting socioeconomic factors explain this relationship to some extent," said lead investigator Shiva Raj Mishra, PhD, of the University of Sydney.

As for the statin gap specifically, researchers point to several possible explanations: side-effect concerns, an underestimation of personal cardiac risk, and competing social priorities such as caregiving responsibilities.

A broader problem — for everyone

The study also underscores that medication adherence after ACS is low across the board. Overall, just over half of all patients — men and women combined — were consistently taking all five cardioprotective medications at 6 and 12 months. Patients with more comorbidities fared even worse, likely because managing multiple conditions simultaneously makes complex medication regimens harder to follow.

"Just knowing and having a serious cardiac event alone is clearly not sufficient as an intervention," said Mishra. "More is needed to address this."

"Medical adherence is important and difficult to achieve for many patients, and even more so for women compared to men. We should always be asking about medical adherence after ACS, especially among our patients with socioeconomic barriers to care."

— Clara Chow, MBBS, PhD, University of Sydney

Sources

Mishra SR et al. Open Heart, 2026. TEXTMEDS randomized clinical trial.

O'Riordan M. "Women Less Likely Than Men to Adhere to Post-ACS Medications: TEXTMEDS." TCTMD, April 13, 2026.