Key result
Smoking is linked to ~115% higher AF ablation recurrence risk, alongside periodontitis and metabolic syndrome.
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Why the study?
Arrhythmia recurrence following AF catheter ablation remains a major clinical challenge, but the clinical risk factors for recurrence are not well defined.
Do baseline clinical risk factors predict post-ablation arrhythmia recurrence in atrial fibrillation patients undergoing catheter ablation?
Meta-Analysis (n=49,919)
Do baseline clinical risk factors predict post-ablation arrhythmia recurrence in atrial fibrillation patients undergoing catheter ablation?
Effect estimate: aHR 2.15 (95% CI 1.49-3.10)
Multiple modifiable clinical risk factors, notably smoking, periodontitis, metabolic syndrome, and sleep apnea, strongly predict arrhythmia recurrence after AF ablation, highlighting the importance of pre-procedural optimization.
Should not yet change practice in arrhythmia patients; leaves open whether smoking cessation reduces recurrence pending RCTs.
BACKGROUND: Arrhythmia recurrence after atrial fibrillation (AF) catheter ablation remains a substantial clinical challenge, but risk factors of arrhythmia recurrence are not well defined. OBJECTIVE: This study aimed to elucidate baseline clinical risk factors for post-ablation recurrence and variations by AF phenotype and study heterogeneity. METHODS: 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. RESULTS: 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. CONCLUSIONS: Expanded pre-ablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and pre-procedural optimization.
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Chan et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=49,919). Clinical risk factors (e.g., smoking, periodontitis, metabolic syndrome) was evaluated on post-ablation arrhythmia recurrence (aHR 2.15, 95% CI 1.49-3.10). Smoking (aHR 2.15; 95% CI 1.49-3.10), periodontitis, and metabolic syndrome were identified as the strongest baseline clinical risk factors for arrhythmia recurrence after AF catheter ablation.
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