Visceral Embolic Events in Atrial Fibrillation - A Systematic Review and Meta-Analysis of Incidence, Mortality, and Risk Prediction

Q: What are visceral embolic events in atrial fibrillation?

Visceral embolic events include mesenteric, splenic, and renal infarctions that occur as complications of atrial fibrillation, often underreported within broader systemic embolic event categories.

Q: How was VEE incidence and prevalence estimated in this review?

The review searched major databases through September 2024 and used event-definition-based subgrouping to pool prevalence estimates with random-effects meta-analysis, reporting 95% prediction intervals.

Q: What factors were explored as potential predictors of VEE?

Potential predictors included left atrial enlargement, elevated D-dimer levels, and higher CHA2DS2-VASc scores, though the authors note validation in independent cohorts is lacking.

Sep 30, 2026

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Visceral embolic events (VEE), including mesenteric, splenic, and renal infarctions, are understudied complications of atrial fibrillation (AF) often grouped within broader systemic embolic categories. This systematic review synthesizes evidence on VEE incidence, mortality, and risk predictors. Searches of PubMed, Embase, Scopus, and Web of Science (through September 2024) identified 12 studies (n=329,128). Event-definition-based subgroup meta-analysis reduced heterogeneity (I2=99.6% to 45.4%) and estimated pooled non-AMI VEE prevalence at 1.6% (95% CI 0.0–3.2%). Mortality varied widely (17.4–64.0%) by patient age and concurrent acute myocardial infarction; potential predictors included left atrial enlargement, elevated D-dimer, and higher CHA2DS2-VASc scores, pending external validation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages29

Reading Time1 h 13 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

1. Introduction

Systematic Review Visceral Embolic Events in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Incidence, Mortality, and Risk Prediction Yazan Jumah Alalwani 1, Waleed Abdullah Alharthi 2, Hadeel Khalid Bin-Shuiel 3, Raghad Adel Badoghaish 1, Saja Fawzi Alzanbaqi 4, Lamees Naji Alsaleh 2, Fatimah Essam Alzaid 1, Mustafa Abdulwahab AlShayeb 1, Fatimah Reda Algawez 1, Rama Khalid Alsulaim 5, Shomoukh Abdullah Alnabtawi 6, Ahmed Y. Azzam 7, *,† and Eiman Mohammed AlShammari 8,† Academic Editor: Boyoung Joung Received: 30 October 2025 Revised: 25 November 2025 Accepted: 4 December 2025 Published: 26 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia; [2200005494@iau.edu.sa](2200005494@iau.edu.sa) (F.E.A.) 2 College of Medicine, Dar Al Uloom University, Riyadh 11512, Saudi Arabia 3 College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia 4 College of Medicine, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia 5 College of Medicine, Qassim University, Buraydah 51452, Saudi Arabia 6 Faculty of Medicine, Hail University, Hail 81451, Saudi Arabia 7 Clinical Research and Clinical Artificial Intelligence, ASIDE Healthcare, Lewes, DE 19958, USA 8 Department of General Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia; [ealshammare@iau.edu.sa](ealshammare@iau.edu.sa) * Correspondence: [ahmedyazzam@gmail.com](ahmedyazzam@gmail.com); Tel.: +20-102-376-1345 † These authors contributed equally to this work. Abstract Background: Visceral embolic events (VEE), including mesenteric, splenic, and renal infarctions, represent understudied complications of atrial fibrillation (AF) often subsumed within broader systemic embolic event categories. The 2024 European Society of Cardiology guidelines introduced the CHA 2DS2-VA score, removing female sex as a risk modifier, with potential implications for non-cerebral embolic risk stratification. We systematically synthesized evidence on VEE incidence, mortality, and risk predictors in AF patients. Methods: We searched PubMed, Embase, Scopus, and Web of Science through September 2024 for studies reporting VEE in AF populations. Study quality was assessed using the Newcastle–Ottawa Scale (NOS) . Due to substantial heterogeneity when pooling all prevalence studies (I2 = 99.6%), we performed event-definition-based subgroup analyses. Random-effects meta-analyses were conducted using DerSimonian–Laird methods with 95% prediction intervals. Sensitivity analyses excluded studies with NOS scores < 7 to assess robustness. Results: We identified 12 studies including 329,128 patients. Quality assessment revealed a mean NOS score of 6.7 ± 1.6 (range: 4–9), with 75% of studies achieving good-to-excellent ratings. For non-AMI visceral embolic events (splenic, renal, mesenteric infarctions), subgroup meta-analysis of three studies (n = 548) yielded a pooled prevalence of 1.6%(95% CI: 0.0–3.2%, I2 = 45.4%, p = 0.160), representing a 54.2 percentage point reduction in heterogeneity compared to pooling all event types. Sensitivity analysis excluding moderate-quality studies confirmed robust findings (pooled prevalence 2.7%, 95% CI: 0.0–6.8%, I2 = 70.3%) . Incidence rates ranged from 0.36 to 3.48 per 1000 personyears across three cohort studies (I2 = 99.4%), reflecting temporal and geographic variation. Mortality varied substantially by patient population: 64.0% in-hospital mortality among elderly patients with concurrent acute myocardial infarction (AMI) versus 17.4% in younger cohorts with isolated non-AMI VEE. Potential predictors included left atrial enlargement (OR range: 2.1–4.3), elevated D-dimer

FAQs

What are visceral embolic events in atrial fibrillation?

Visceral embolic events include mesenteric, splenic, and renal infarctions that occur as complications of atrial fibrillation, often underreported within broader systemic embolic event categories.

How was VEE incidence and prevalence estimated in this review?

The review searched major databases through September 2024 and used event-definition-based subgrouping to pool prevalence estimates with random-effects meta-analysis, reporting 95% prediction intervals.

What factors were explored as potential predictors of VEE?

Potential predictors included left atrial enlargement, elevated D-dimer levels, and higher CHA2DS2-VASc scores, though the authors note validation in independent cohorts is lacking.

Sep 30, 2026

Upload by Indoniesian Boy