Review – Temporal trends in atrial fibrillation catheter ablation efficacy: A systematic review, meta-analysis and meta-regression from more than 20 years of clinical data

​Jonaz Font, Charles Dolladille, Damien Legallois, Mayane Al Khoury, Laure Champ-Rigot, Corentin Chaumont, Virginie Ferchaud, Arnaud Pellissier, Avi Sabbag, Frédéric Anselme, Paul Milliez, Pierre Ollitrault

Early rhythm control has been shown to improve cardiovascular outcomes in patients with atrial fibrillation. Atrial fibrillation catheter ablation is a cornerstone of this strategy; however, the evolution of its efficacy over time remains unclear. This study aimed to evaluate temporal trends in atrial fibrillation catheter ablation efficacy over the past two decades. A systematic review was conducted using PubMed and the Cochrane Library, covering studies published between 01 January 2001 and 01 July 2023. Atrial fibrillation catheter ablation efficacy was defined as the absence of atrial arrhythmia recurrence (atrial fibrillation, atrial tachycardia and/or atrial flutter) at 12-month follow-up after a single ablation procedure,without the use of antiarrhythmic drugs. A random-effects meta-analysis of proportions was performedusing a generalized linear mixed model. Meta-regression was employed to assess the impact of treat-ment year on ablation success. The study was registered in the PROSPERO registry: CRD42021258100. The analysis included 477 cohorts comprising 70,703 patients. The pooled estimate of atrial fibrillation catheter ablation efficacy was 66% (95% confidence interval 64% to 67%). A significant improvement inefficacy was observed over time (+1.09% per year; 95% confidence interval: 0.71% to 1.56%; P < 0.0001;R2= 7%). However, this improvement was primarily driven by early gains (before 2010) in patients with persistent atrial fibrillation. No evidence of publication bias was detected. This is the largest meta-analysis to date assessing temporal trends in atrial fibrillation catheter ablation efficacy. Although a modest, but statistically significant, improvement has occurred over the past two decades, progress has plateaued since 2010. These findings highlight the need for a paradigm shift in atrial fibrillation catheter ablation strategies, with a focus on improving lesion durability and integrating ablation within a comprehensive atrial fibrillation management approach aimed at sustained sinus rhythm maintenance.

• Atrial fibrillation

• Catheter ablation
• Outcome
• Meta-analysis
• Meta-regression

1. Abbreviations
2. Background
3. Methods
4. Results
5. Discussion
6. Conclusions

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