Arrhythmias & electrophysiology
Identification of clinical risk factors for arrhythmia recurrence in patients with atrial fibrillation undergoing catheter ablation: A systematic review and meta-analysis
Authors' conclusion
Expanded preablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and preprocedural optimization.
Study context
- Population
- Patients with atrial fibrillation undergoing catheter ablationpatients in 152 studies
- Participants
- 49,919 patients
- Comparison
- Baseline clinical risk factors and postablation arrhythmia recurrence
- Outcome
- Postablation arrhythmia recurrence by clinical risk factor (pooled aHRs)
Methodological detailsprospective cohort studies, random-effects meta-analyses, Newcastle-Ottawa scale quality assessment, subgroup, meta-regression, and sensitivity analyses, 8 databases searched up to 31 December 2025
- Prospective cohort studies
- Random-effects meta-analyses
- Newcastle-Ottawa scale quality assessment
- Subgroup, meta-regression, and sensitivity analyses
- 8 databases searched up to 31 December 2025
Pooled result
As reported in the abstract
Adjusted hazard ratio (CI)
Smoking
2.15(1.49–3.10)
Periodontitis
2.04(1.48–2.83)
Metabolic syndrome
1.71(1.12–2.62)
Sleep apnea
1.65(1.31–2.09)
Persistent AF
1.64(1.53–1.76)
Further pooled results
Recurrence with untreated sleep apnea and uncontrolled hypertension
| aHR (CI) | ||
|---|---|---|
| Untreated sleep apnea | 2.41 (1.51–3.86) | |
| Uncontrolled hypertension | 1.67 (1.12–2.40) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Sensitivity analyses pooling adjusted odds ratios (aORs)
| aOR (CI) | ||
|---|---|---|
| Depression | 2.86 (1.51–5.41) | |
| Anxiety | 2.54 (1.59–4.04) | |
| 0.20.5125Adjusted odds ratio (log scale) |
Subgroup analyses by atrial fibrillation (AF) phenotype
- No difference across AF phenotypes
Meta-regression
- Ablation modality a significant moderator for AF history; geographic region for female sex, heart failure, and diabetes
Original publication
Identification of clinical risk factors for arrhythmia recurrence in patients with atrial fibrillation undergoing catheter ablation: A systematic review and meta-analysis. Heart Rhythm. Published 29 April 2026. doi:10.
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