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

Abstract 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.