ESC Congress 2026 Abstract · Oct 26, 2026
Major adverse cardiovascular events and their predictors in patients with atrial fibrillation undergoing pulmonary vein isolation: the Swiss-AF-PVI study
By Herren V, Aeschbacher S, Voellmin G et al.
Introduction: Pulmonary vein isolation (PVI) represents a central therapeutic strategy in patients with atrial fibrillation (AF). Although the efficacy of PVI in rhythm control is well established, data on major adverse cardiovascular events (MACE) during long-term follow-up after PVI and their predictors remain limited. Purpose: This study aimed to determine the occurrence of MACE in patients with AF undergoing PVI, and to identify predictors of MACE during long-term follow-up after PVI. Methods: All patients undergoing index PVI with available follow-up of ≥1 year were included. The primary outcome was the occurrence of MACE, defined as a composite of cardiovascular death, stroke, hospitalization for heart failure, or myocardial infarction. Secondary outcomes comprised the individual components of the primary endpoint, all-cause death, major and clinically relevant non-major bleeding. All outcome events were reviewed and validated by two independent physicians. Logistic regression analysis was done to investigate potential predictors for MACE. Results: A total of 2273 patients were included. The median age was 65 years (IQR 57; 71), 683 (30.0%) were female and median CHA2DS2-VASc score was 2 (IQR 1;3). Overall, 120 patients (5.3%) experienced at least one MACE during a median follow-up of 30 months. Among the individual MACE components, cardiovascular death was the most frequent event, occurring in 50 patients (2.2%), followed by hospitalization for heart failure (n = 39, 1.7%), stroke (n = 29, 1.3%), and myocardial infarction (n = 21, 0.9%). All-cause mortality was observed in 73 patients (3.2%). Major bleeding events occurred in 33 patients (1.45%), while clinically relevant non-major bleeding was documented in 92 patients (4.1%). LVEF before index PVI (Odds Ratio (95%CI) 0.96 (0.94; 0.98), p<0.001) and regular sports (0.49 (0.29; 0.81), p<0.001) were strongly associated with MACE (Table). Conclusion: Patients with AF undergoing PVI have a relatively low risk of major adverse cardiovascular events during follow-up. Regular physical exercise and efforts to maintain LVEF may be essential to modify risk.