Key result
Frailty is linked to ~57% higher risk of arrhythmia recurrence after AF catheter ablation.
Why the study?
Atrial tachyarrhythmia recurrence after catheter ablation for AF remains common in older patients with comorbidities, and the impact of frailty on post-ablation recurrence had not been systematically quantified.
Does frailty increase the risk of atrial tachyarrhythmia recurrence in adults undergoing catheter ablation for atrial fibrillation?
Meta-Analysis (n=1,096)
Yes
Does frailty increase the risk of atrial tachyarrhythmia recurrence in adults undergoing catheter ablation for atrial fibrillation?
Frailty is associated with a 57% higher relative risk of atrial tachyarrhythmia recurrence following catheter ablation for atrial fibrillation, supporting the integration of frailty screening into pre-procedural risk stratification and shared decision-making.
Frailty is an increasingly recognized marker of biological vulnerability in patients with atrial fibrillation (AF). Although catheter ablation (CA) is an established rhythm-control strategy, atrial tachyarrhythmia (AT) recurrence remains common, particularly in patients with advanced age and comorbidity burden. The impact of frailty on post-ablation recurrence has not been systematically quantified. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies evaluating the association between frailty and AT recurrence following CA for AF. Eligible studies compared frail and non-frail adults undergoing CA and reported post-procedural recurrence. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Four studies totaling 1096 patients were included, of whom 266 (24.3%) were frail. Across the included studies, the mean age of participants ranged from approximately 61 to 76 years. Frailty was associated with a significantly higher risk of AT recurrence after CA compared with non-frailty (RR, 1.57; 95% CI, 1.26–1.94; P < .001; I2 = 0%). This association remained significant in subgroup analyses limited to studies with ≤12 months of follow-up (RR, 1.46; 95% CI, 1.13–1.89; P = .004; I2 = 0%). Leave-one-out sensitivity analyses confirmed robustness. In conclusion, frailty is independently associated with increased AT recurrence following CA for AF and should be considered in pre-procedural risk stratification.
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Bilal et al. (2026) conducted a meta-analysis in Atrial fibrillation undergoing catheter ablation (n=1,096). Frailty vs. Non-frail status was evaluated on Atrial tachyarrhythmia (AT) recurrence (defined as any documented AF, atrial flutter, or atrial tachycardia lasting >30 seconds during post-ablation follow-up) (RR 1.57, 95% CI 1.26-1.94, p=<0.001). Frailty was associated with a significantly higher risk of atrial tachyarrhythmia recurrence after catheter ablation for atrial fibrillation compared with non-frailty (RR 1.57; 95% CI 1.26-1.94; P < .001).
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