Visceral Embolic Events in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Incidence, Mortality, and Risk Prediction
Bibliographic record
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 CHA2DS2-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 person-years 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 (OR: 3.2), and higher CHA2DS2-VASc scores (OR: 1.3 per point increase), though validation in independent cohorts is lacking. Conclusions: Visceral embolic events occur in approximately 1–6% of AF patients, with mean prevalence of 1.6% for non-AMI events based on moderate-heterogeneity meta-analysis. Event-definition-based subgrouping successfully reduced heterogeneity from 99.6% to 45.4%, providing the first reliable pooled estimate for this outcome. Mortality ranges widely (17–64%) depending on concurrent AMI and patient age. Potential predictors including left atrial enlargement and elevated D-dimer require prospective validation before clinical implementation. These findings suggest VEE may warrant enhanced clinical awareness and individualized risk assessment strategies in AF management, pending validation in prospective studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.038 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.042 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".