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Review
. 2025 Jan 13;77(1):9.
doi: 10.1186/s43044-025-00605-7.

Risk factors for the recurrence of atrial fibrillation after catheter ablation: a meta-analysis

Gonghao Li  1   2 , Yanli Zhao  3 , Zhongxing Peng  3 , Yunfeng Zhao  3
Affiliations
Review

Risk factors for the recurrence of atrial fibrillation after catheter ablation: a meta-analysis

Gonghao Li et al. Egypt Heart J. .

Abstract

Background: The rate at which atrial fibrillation (AF) patients experience a return of symptoms after catheter ablation is significant, and there are multiple risk factors involved. This research intends to perform a meta-analysis to explore the risk factors connected to the recurrence of AF in patients following catheter ablation.

Methods: The PubMed, Cochrane Library, WOS, Embase, SinoMed, CNKI, Wanfang, and VIP databases were explored for studies from January 1, 2000 to August 10, 2021, and research meeting the established inclusion requirements was chosen. Two authors separately gathered details regarding the study structure. The strength of the link between various risk factors and AF returning after CA was evaluated using odds ratios. All statistical evaluations were conducted with RevMan5.3 software.

Results: In total, 44 articles and 62,674 patients were included. The OR for AF recurrence in patients with diabetes was 2.04 compared with the reference group (95% CI 1.51-2.76, p < 0.00001); that of lower left ventricular ejection fraction was 1.38 (95% CI 1.25-1.52, p < 0.00001); that of female was 1.34 (95% CI 1.18-1.52, p < 0.00001); that of increased age was 1.03 (95% CI 1.02-1.04, p < 0.00001); that of persistent AF was 1.72 (95% CI 1.58-1.87, p < 0.00001); that of AF duration over 2 years was 1.17 (95% CI 1.08-1.26, p < 0.00001); that of increased left atrial diameter (LAD) was 1.12 (95% CI 1.08-1.17, p < 0.00001); that of larger left atrial volume index (LAVi) was 1.02 (95% CI 1.01-1.03, p < 0.00001); that of higher hs-CRP was 1.19 (95% CI 1.04-1.36, p = 0.04); that of early recurrence (ER) was 3.22 (95% CI 2.74-3.77, p < 0.00001); and that of long ablation duration was 1.00 (95% CI 0.98-1.02, p = 0.72). Heterogeneity and slight publication bias were observed for each factor.

Conclusions: Evidence indicates that diabetes, low left ventricular ejection fraction, being female, older age, longer duration of atrial fibrillation, elevated high-sensitivity C-reactive protein levels, large left atrial dimension, large left atrial volume index, persistent atrial fibrillation, and exercise rehabilitation are factors that increase the chances of getting atrial fibrillation again after catheter ablation. However, the length of the ablation procedure does not relate to the recurrence of AF.

Keywords: Atrial fibrillation; Catheter ablation; Recurrence; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Forest plot for risk factors. A Forest plot for diabetes. B Forest plot for heart failure. C Forest plot for gender. D Forest plot for age. E Forest plot for ablation duration. F Forest plot for AF types. G Forest plot for AF duration. H Forest plot for LAD. I Forest plot for LAVi. J Forest plot for hs-CRP. K Forest plot for ER. AF: atrial fibrillation; LAD: left atrial diameter; LAVi: left atrial volume index; CRP: C-reaction protein
Fig. 3
Fig. 3
Funnel plot for risk factors. A Funnel plot for diabetes. B Funnel plot for heart failure. C Funnel plot for gender. D Funnel plot for age. E Funnel plot for ablation duration. F Funnel plot for AF types. G Funnel plot for AF duration. H Funnel plot for LAD. I Funnel plot for LAVi. J Funnel plot for hs-CRP. K Funnel plot for ER. AF: atrial fibrillation; LAD: left atrial diameter; LAVi: left atrial volume index; CRP: C-reaction protein
See this image and copyright information in PMC

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