Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation? A meta-analysis

F. D'Ascenzo*, A. Corleto, G. Biondi-Zoccai, M. Anselmino, F. Ferraris, L. Di Biase, A. Natale, R. J. Hunter, R. J. Schilling, S. Miyazaki, H. Tada, K. Aonuma, L. Yenn-Jiang, H. Tao, C. Ma, D. Packer, S. Hammill, F. Gaita

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

160 Scopus citations


Context: Transcatheter ablation of atrial fibrillation (AF) has undergone important development, with acceptable midterm results in terms of the safety and recurrence. A meta-analysis was performed to identify the periprocedural complications, midterm success rates and predictors of recurrence after AF ablation. Methods and results: 4357 patients with paroxysmal AF, 1083 with persistent AF and 1777 with long standing AF were included. The pooled analysis showed that there was an in-hospital complication rate of tamponade requiring drainage of 0.99% (0.44-1.54; CI 99%), stroke with neurological persistent impairment of 0.22% (0.04-0.47; CI 99%), and stroke without of 0.36% (0.03-0.70; CI 99%) After a follow up of 22 (13-28) months and 1.23 (1.19-1.5; CI 99%) procedures per patient, the AF recurrence rate was 31.20% (24.87-34.81; CI 99%). The persistent AF patients exhibited a greater risk of recurrence after the first ablation (OR 1.78 [1.14, 2.77] CI 99%), but a trend towards non significance was present in the patients with more than one procedure (OR 1.69 [0.95, 3.00] CI 99%). The most powerful predictors of an AF ablation failure in the overall population were a recurrence within 30-days (OR 4.30; 2.00-10.80), valvular AF (OR 5.20; 2.22-9.50) and a left atrium diameter of more than 50 mm (OR 5.10 2.00-12.90; all CI 95%). Conclusions: Persistent AF remains burdened from higher recurrence rates, however not so following redo-procedures. Three predictors, valvular AF, a left atrium diameter longer than 50 mm and recurrence within 30 days, could be appraised to drive selection of patients and therapeutic strategy.

Original languageEnglish
Pages (from-to)1984-1989
Number of pages6
JournalInternational Journal of Cardiology
Issue number5
StatePublished - 1 Sep 2013


  • Atrial fibrillation
  • Catheter ablation
  • Meta-analysis
  • Multivariate predictors
  • Recurrence
  • Systematic review


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