Identification of Clinical Risk Factors for Arrhythmia Recurrence in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Systematic review and Meta-analysis.
Arrhythmia recurrence after atrial fibrillation (AF) catheter ablation remains a substantial clinical challenge, but risk factors of arrhythmia recurrence are not well defined.
This study aimed to elucidate baseline clinical risk factors for post-ablation recurrence and variations by AF phenotype and study heterogeneity.
We systematically searched eight databases for prospective cohort studies assessing associations between clinical risk factors and post-ablation arrhythmia recurrence up to 31 December 2025. Study quality was evaluated using Newcastle-Ottawa scale. Multivariable-adjusted hazard ratios (aHRs) were pooled through random-effects meta-analyses with subgroup, meta-regression, and sensitivity analyses.
Among 152 studies involving 49,919 patients, 16 clinical risk factors were identified. In primary meta-analysis pooling aHRs, the strongest associations were observed for smoking (aHR:2.15 [1.49-3.10)]), periodontitis (aHR:2.04 [1.48-2.83]), metabolic syndrome (aHR:1.71 [1.12-2.62]), sleep apnea (aHR:1.65 [1.31-2.09]) and persistent AF (aHR:1.64 [1.53-1.76]), followed by chronic kidney disease, alcohol consumption, overweight/ obesity, diabetes mellitus, female sex, hypertension, AF history, left atrial enlargement and impaired left ventricular ejection fraction. Untreated sleep apnea (aHR:2.41 [1.51-3.86]) and uncontrolled hypertension (aHR:1.67 [1.12-2.40]) conferred heightened risks. Sensitivity analyses pooling adjusted odds ratios (aORs) additionally identified depression (aOR:2.86 [1.51-5.41]), anxiety (aOR:2.54 [1.59-4.04]). Subgroup analyses revealed no difference across AF phenotypes. Meta-regression identified ablation modality as a significant moderator for AF history, and geographic region for female sex, heart failure and diabetes.
Expanded pre-ablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and pre-procedural optimization.
This study aimed to elucidate baseline clinical risk factors for post-ablation recurrence and variations by AF phenotype and study heterogeneity.
We systematically searched eight databases for prospective cohort studies assessing associations between clinical risk factors and post-ablation arrhythmia recurrence up to 31 December 2025. Study quality was evaluated using Newcastle-Ottawa scale. Multivariable-adjusted hazard ratios (aHRs) were pooled through random-effects meta-analyses with subgroup, meta-regression, and sensitivity analyses.
Among 152 studies involving 49,919 patients, 16 clinical risk factors were identified. In primary meta-analysis pooling aHRs, the strongest associations were observed for smoking (aHR:2.15 [1.49-3.10)]), periodontitis (aHR:2.04 [1.48-2.83]), metabolic syndrome (aHR:1.71 [1.12-2.62]), sleep apnea (aHR:1.65 [1.31-2.09]) and persistent AF (aHR:1.64 [1.53-1.76]), followed by chronic kidney disease, alcohol consumption, overweight/ obesity, diabetes mellitus, female sex, hypertension, AF history, left atrial enlargement and impaired left ventricular ejection fraction. Untreated sleep apnea (aHR:2.41 [1.51-3.86]) and uncontrolled hypertension (aHR:1.67 [1.12-2.40]) conferred heightened risks. Sensitivity analyses pooling adjusted odds ratios (aORs) additionally identified depression (aOR:2.86 [1.51-5.41]), anxiety (aOR:2.54 [1.59-4.04]). Subgroup analyses revealed no difference across AF phenotypes. Meta-regression identified ablation modality as a significant moderator for AF history, and geographic region for female sex, heart failure and diabetes.
Expanded pre-ablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and pre-procedural optimization.