What does this research mean for the field?

A prior history of hyperthyroidism significantly increases the risk of atrial fibrillation recurrence following catheter ablation, even in patients who have achieved euthyroid status. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis investigates how prior hyperthyroidism and thyroid hormone levels affect the recurrence of atrial fibrillation after catheter ablation.

June 27, 2026EP EuropaceOpen Access

Impact of prior hyperthyroidism and thyroid hormone elevations on atrial fibrillation recurrence after catheter ablation: a time-to-event meta-analysis of adjusted data

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Why the study?

Whether a prior history of hyperthyroidism increases the recurrence of AF after catheter ablation was poorly understood.

Does prior hyperthyroidism or elevated thyroid hormone levels increase the recurrence of atrial fibrillation in patients undergoing catheter ablation?

Key Points

This analysis investigates how prior hyperthyroidism and thyroid hormone levels affect the recurrence of atrial fibrillation after catheter ablation.
Systematic search of PubMed, Embase, and Cochrane for studies on hyperthyroidism impact on AF recurrence.
Analysis of adjusted hazard ratios (HRs) for FT3 and FT4 quartiles as predictors of AF recurrence.
Use of random effects model to pool data and assess heterogeneity.
History of overt or subclinical hyperthyroidism increases AF recurrence (HR 2.00; 95% CI 1.31-3.06; p=0.0083).
High FT4 quartiles are associated with increased AF recurrence (HR 1.24; 95% CI 1.16-1.32; p=0.0019).
FT3 elevations show no significant association with AF recurrence post-ablation (HR 1.40; 95% CI 0.67-2.89; p=0.1085).

Structured PICO

Does prior hyperthyroidism or elevated thyroid hormone levels increase the recurrence of atrial fibrillation in patients undergoing catheter ablation?

Population

10 studies comprising 4,741 patients undergoing catheter ablation for atrial fibrillation.

Intervention

Prior history of overt or subclinical hyperthyroidism, or elevated quartiles of free thyroxine (FT4) and free triiodothyronine (FT3) within the euthyroid range.

Comparator

No prior history of hyperthyroidism, or reference/lower quartiles of FT4 and FT3.

Outcome

Recurrence of atrial fibrillation after catheter ablation.hard clinical

A prior history of hyperthyroidism or high-normal FT4 levels significantly increases the risk of atrial fibrillation recurrence following catheter ablation, suggesting a need for closer monitoring in these patients.

Implication

Prior hyperthyroidism history doubles AF recurrence after ablation; supports pre-procedure thyroid assessment and targeted trials.

Abstract

Background Hyperthyroidism is well-recognised as a reversible cause of atrial fibrillation (AF). However, whether prior history of hyperthyroidism increases the recurrence of AF after catheter ablation is poorly understood. Purpose To determine the prognostic impact of prior hyperthyroidism and elevated thyroid hormone levels within the normal range on AF recurrence post-catheter ablation. Methods We systematically searched PubMed, Embase, and Cochrane databases for studies assessing the impact of overt or subclinical hyperthyroidism on the recurrence of AF after catheter ablation. Elevated quartiles of free triiodothyronine (FT3) and free thyroxine (FT4) within the euthyroid range were also meta-analysed as predictors of AF recurrence. Log-hazard ratio (HR) transformations were used to standardise FT3 and FT4 quartiles into a consistent high-versus-reference comparison across studies. To minimize confounding, we pooled adjusted HRs and their 95% confidence intervals (CIs) using a random effects model. Heterogeneity was evaluated using the Cochrane Q test and I² statistics; p values inferior to 0.10 and I² > 25% were deemed significant for heterogeneity. Results Ten studies comprising 4,741 patients were included. Previous history of overt or subclinical hyperthyroidism significantly increased the recurrence of AF after catheter ablation (HR 2.00; 95% CI 1.31-3.06; p = 0.0083; I² = 16.9%; Figure 1). In euthyroid patients, high quartiles of FT4 were strongly associated with the recurrence of AF (HR 1.24; 95% CI 1.16-1.32; p = 0019; I² = 0.0%; Figure 2). Despite an observable trend, FT3 elevations were not significantly associated with the recurrence of AF post-ablation (HR 1.40; 95% CI 0.67-2.89; p = 0.1085; I² = 0.0%). Conclusion Prior history of hyperthyroidism increases the risk of AF recurrence in patients undergoing catheter ablation, even after restoration of euthyroid status. Thorough assessments of FT4, and potentially FT3, during follow-up may help identify patients at an increased risk of AF recurrence.Figure 1.History of hyperthyroidismFigure 2.Elevated FT4 levels