Cited by 800Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

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Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis

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Ganesan, Anand N., Shipp, Nicholas J., Brooks, Anthony G., Kuklik, Pawel, Lau, Dennis H., Lim, Han S., Sullivan, Thomas, Roberts‐Thomson, Kurt C., Sanders, Prashanthan·2013·Journal of the American Heart Association

DOI 10.1161/jaha.112.004549PMC PMC3647286

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Abstract

BACKGROUND: In the past decade, catheter ablation has become an established therapy for symptomatic atrial fibrillation (AF). Until very recently, few data have been available to guide the clinical community on the outcomes of AF ablation at ≥3 years of follow-up. We aimed to systematically review the medical literature to evaluate the long-term outcomes of AF ablation. METHODS AND RESULTS: A structured electronic database search (PubMed, Embase, Web of Science, Cochrane) of the scientific literature was performed for studies describing outcomes at ≥3 years after AF ablation, with a mean follow-up of ≥24 months after the index procedure. The following data were extracted: (1) single-procedure success, (2) multiple-procedure success, and (3) requirement for repeat procedures. Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single-procedure freedom from atrial arrhythmia at long-term follow-up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF. Substantial heterogeneity (I(2)>50%) was noted for single-procedure outcomes. With multiple procedures, the long-term success rate was 79.8% (95% CI 75.0% to 83.8%) overall, with significant heterogeneity (I(2)>50%).The average number of procedures per patient was 1.51 (95% CI 1.36 to 1.67). CONCLUSIONS: Catheter ablation is an effective and durable long-term therapeutic strategy for some AF patients. Although significant heterogeneity is seen with single procedures, long-term freedom from atrial arrhythmia can be achieved in some patients, but multiple procedures may be required.

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Figure 1. Search criteria and flow diagram for studies included in this systematic review. AF indicates atrial fibrillation; SVT, supraventricular tachycardia; AV, atrioventricular; CRT, cardiac resynchronization therapy; RA, right atrial.CC BY · PubMed Central

Figure 2. Single‐procedure success at 12 months postprocedure (A) and at late follow‐up (B). AF indicates atrial fibrillation.CC BY · PubMed Central

Figure 3. Multiple late procedure success, defined as the cumulative arrhythmia‐free survival at ≥3 years. AF indicates atrial fibrillation.CC BY · PubMed Central

Figure 4. A, Annualized single‐ and multiple‐ procedure arrhythmia‐free success were calculated (subtable number of studies at each year after ablation). B, Annualized PAF and NPAF single‐procedure arrhythmia‐free success were calculated (subtable number of studies at each year after ablation). Meta‐analysis for NPAF was not performed beyond 4 years, because only 2 studies reported at this duration of follow‐up. PAF indicates paroxysmal atrial fibrillation; NPAF, nonparoxysmal atrial fibrillation.CC BY · PubMed Central

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Meta-analysis in clinical trials
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Authors: Ganesan, A. N., Shipp, N. J., Brooks, A. G., Kuklik, P., Lau, D. H., Lim, H. S., Sullivan, T., Roberts‐Thomson, K. C., & Sanders, P.
Affiliations: Royal Adelaide Hospital (AU)
Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
Corresponding author: Sanders, Prashanthan
ORCID: Ganesan, Anand N.
Lau, Dennis H.
Lim, Han S.
Sullivan, Thomas
Sanders, Prashanthan
Venue: Journal of the American Heart Association
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-03-12
Volume: 2
Issue: 2
Pages: e004549-e004549
ISSN: 2047-9980 (ISSN-L)
DOI: 10.1161/jaha.112.004549
PMC: PMC3647286
OpenAlex: W2165779304
Cited by: 800
References: 45
Citations by year: 2026: 43 · 2025: 36 · 2024: 62 · 2023: 61 · 2022: 63 · 2021: 65 · 2020: 76 · 2019: 77 · 2018: 74 · 2017: 75 · 2016: 60 · 2015: 53 · 2014: 43 · 2013: 11
FWCI: 9.52
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Journal of the American Heart Association (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, other-oa)
Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: atrial fibrillation, catheter ablation, long-term outcomes, procedural success, repeat procedures, atrial arrhythmia recurrence, paroxysmal atrial fibrillation, non-paroxysmal atrial fibrillation
MeSH terms: Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Longitudinal Studies, Recurrence, Treatment Outcome, Catheter Ablation

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Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis

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