The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.
Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis
Open accessAbstract
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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In the citing paper
“Sinus rhythm without severely symptomatic recurrences of AF is found in up to 70% of patients with paroxysmal AF, and around 50% in persistent AF. 713,728,735,1042”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [728]
In the citing paper
“Very late recurrence of AF after years of sinus rhythm is not uncommon and may reflect disease progression, with important implications for continuation of AF therapies.728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [728]
In the citing paper
“Most patients require more than one procedure to achieve symptom control.713,726,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [728]
In the citing paper
“Very late recurrence of AF after years of sinus rhythm is not uncommon and may reflect disease progression, with important implications for continuation of AF therapies.728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [728]
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Citations
Cites
Meta-analysis in clinical trials
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“A pooled estimate of survival at 12months and the latest follow-upwas calculated, using random-effects models based on logit transformed proportions.(7) The time point of latest follow-up in a study was defined as the last time point reporting a minimum of 30 subjects at risk.”
MethodQuantifying heterogeneity in a meta‐analysis
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“Heterogeneity was assessed with the I(2) statistic, with 50% defined as the threshold for significant heterogeneity.(8) Subgroup analysis and random-effects metaregression were performed to explore possible reasons for heterogeneity of study outcomes.”
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Meta-analysis of Observational Studies in Epidemiology<SUBTITLE>A Proposal for Reporting</SUBTITLE>
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Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
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“C atheter ablation of atrial fibrillation (AF) has become an established therapeutic modality for the treatment of patients with symptomatic AF.(1) To date, studies reporting outcomes of AF ablation have predominantly limited follow-up to 1 to 2 years after the index ablation procedure.”
BackgroundInfluentialGuidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,954
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Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · EP Europace · doi:10.1093/europace/euq350 · Cited by 1,764
Calkins, H. G., Kück, K., Cappato, R., Brugada, J., Camm, A. J., Chen, S., Crijns, H. J. G. M., Damiano, R. J., Davies, D. W., Dimarco, J., et al. (2012) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9672-7 · Cited by 1,685
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2011.12.016 · Cited by 1,456
Cappato, R., Calkins, H. G., Chen, S., Davies, W. D., Iesaka, Y., Kalman, J. M., Kim, Y.-H., Klein, G. J., Packer, D. L., & Skanes, A. C. (2005) · Circulation · doi:10.1161/01.cir.0000157153.30978.67 · Cited by 1,303
Pappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P., Gulletta, S., Gugliotta, F., Pappone, A., Santinelli, V., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00577-1 · Cited by 779 · cited 2×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
MethodCatheter Ablation for Atrial Fibrillation
Weerasooriya, R., Khairy, P., Litalien, J., Macle, L., Hocini, M., Sacher, F., Lellouche, N., Knecht, S., Wright, M. J., Nault, I., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.05.061 · Cited by 735 · cited 3×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
BackgroundMethodLong-Term Results of Catheter Ablation in Paroxysmal Atrial Fibrillation
Ouyang, F. O., Tilz, R. R., Chun, J., Schmidt, B., Wißner, E., Zerm, T., Neven, K. G. E. J., Köktürk, B., Konstantinidou, M., Metzner, A., et al. (2010) · Circulation · doi:10.1161/circulationaha.110.946806 · Cited by 705 · cited 1×
“Mechanisms of Recurrence Mechanisms of recurrence were reported in 5 studies.(16,17,19,21,22) In these 5 studies, 3 of which reported data exclusively from PAF patients, PV reconnection was noted in 417 of 423 patients who underwent repeat ablation; the rate of ≥1 PV reconnection was 97.”
Pericardial Fat Is Associated With Atrial Fibrillation Severity and Ablation Outcome
Wong, C. X. J., Abed, H. S., Molaee, P., Nelson, A. J., Brooks, A. G., Sharma, G., Leong, D. P., Lau, D. H., Middeldorp, M. E., Roberts‐Thomson, K. C., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.11.045 · Cited by 494
Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review
Brooks, A. G., Stiles, M. K., Laborderie, J., Lau, D. H., Kuklik, P., SHIPP, N. J., Hsu, L., & Sanders, P. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.01.017 · Cited by 488
Pereira, C., & Castilho, E. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwp016 · Cited by 365 · cited 2×
“In recent years, however, meta-analysis has become accepted in the literature to aggregate results from observational data, to facilitate synthesis of available evidence and generation of new hypotheses.(37,38) In the case of AF ablation, the procedure is relatively new, with significant ongoing innovation in technolo…”
Ng, C. Y., Liu, T., Shehata, M. M., Stevens, S. M., Chugh, S. S., & Wang, X. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.02.343 · Cited by 363
Atrial remodeling in obstructive sleep apnea: Implications for atrial fibrillation
Dimitri, H. R., Ng, M., Brooks, A. G., Kuklik, P., Stiles, M. K., Lau, D. H., Antic, N. A., Thornton, A., Saint, D. A., McEvoy, R. D., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.10.017 · Cited by 325
Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
Piccini, J. P., Lópes, R. D., Kong, M. H., Hasselblad, V., JACKSON, K. P., & Al‐Khatib, S. M. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.856633 · Cited by 289
Bhargava, M., Biase, L. D., Mohanty, P. K., Prasad, S., Martin, D. O., Williams‐Andrews, M., Wazni, O. M., Burkhardt, J. D., Cummings, J. E., Khaykin, Y., et al. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.06.014 · Cited by 284 · cited 2×
“Mechanisms of Recurrence Mechanisms of recurrence were reported in 5 studies.(16,17,19,21,22) In these 5 studies, 3 of which reported data exclusively from PAF patients, PV reconnection was noted in 417 of 423 patients who underwent repeat ablation; the rate of ≥1 PV reconnection was 97.”
BackgroundBalk, E. M., Garlitski, A. C., Alsheikh-Ali, A. A. A., Terasawa, T., Chung, M. C., & Ip, S. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01798.x · Cited by 259
Long-Term Outcome After Successful Catheter Ablation of Atrial Fibrillation
Tzou, W. S., Marchlinski, F. E., Zado, E. S., Lin, D., Dixit, S., Callans, D. J., Cooper, J. M., Bala, R., Garcia, F. C., Hutchinson, M. D., et al. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.923771 · Cited by 237 · cited 3×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
BackgroundMethodGaïta, F., Caponi, D., Scaglione, M., Montefusco, A., Corleto, A., Monte, F. D., Coin, D., Donna, P. D., & Giustetto, C. (2008) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.108.774885 · Cited by 211 · cited 1×
“The 2 randomized controlled trials reported comparisons of ablation strategies.(14,15) Early studies tended to use nonirrigated conventional ablation catheters, with later published studies using predominantly irrigated ablation catheters.”
ResultRostock, T., Salukhe, T. V., Steven, D., Drewitz, I., Hoffmann, B. A., Bock, K., Servatius, H., Müllerleile, K., Sultan, A., Gosau, N., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.04.012 · Cited by 209
Shah, A. N., Mittal, S., Sichrovsky, T., Cotiga, D., Arshad, A., Maleki, K., Pierce, W., & Steinberg, J. S. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01101.x · Cited by 202 · cited 1×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
MethodNatural History and Long-Term Outcomes of Ablated Atrial Fibrillation
Hussein, A. A., Saliba, W. I., Martin, D. O., Bhargava, M., Sherman, M., Magnelli-Reyes, C., Chamsi‐Pasha, M. A., John, S., Williams‐Andrews, M., Baranowski, B. J., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.962100 · Cited by 165 · cited 2×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
MethodShrier, I., Boivin, J.-F., Steele, R. J., Platt, R. W., Furlan, A., Kakuma, R., Brophy, J. M., & Rossignol, M. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm189 · Cited by 161
Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: Results from Long-Term Follow-Up
MEDI, C., SPARKS, P. B., Morton, J. B., Kistler, P. M., Halloran, K. M., Rosso, R., Vohra, J. K., Kumar, S., & Kalman, J. M. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01885.x · Cited by 151 · cited 1×
“Mechanisms of Recurrence Mechanisms of recurrence were reported in 5 studies.(16,17,19,21,22) In these 5 studies, 3 of which reported data exclusively from PAF patients, PV reconnection was noted in 417 of 423 patients who underwent repeat ablation; the rate of ≥1 PV reconnection was 97.”
Bertaglia, E., Tondo, C., Simone, A. D., Zoppo, F., Mantica, M., Turco, P., Iuliano, A., Forleo, G. B., Rocca, V. L., & Stabile, G. (2009) · EP Europace · doi:10.1093/europace/eup349 · Cited by 150
Li, W., Bai, Y., Zhang, H., Tang, R., Miao, C., Sang, C., Yin, X., Dong, J., & Ma, C. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.958405 · Cited by 133 · cited 1×
“Comparisons to Previous Meta-analyses Over the years, a number of studies have addressed the shorter-term outcomes, predictors of recurrence,(28,29) or impact of specific types of ablation strategy.(35,36) The current study, for the first time, addresses the significant clinical issue of the long-term clinical outcome…”
ResultChambers, D., Rodgers, M., & Woolacott, N. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2008.12.010 · Cited by 121 · cited 2×
“Study quality was assessed using a modified version of quality assessment criteria for case series.(6)”
MethodFive-Year Outcomes After Segmental Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation
Sawhney, N. S., Anousheh, R., Chen, W., Narayan, S. M., & Feld, G. K. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.03.044 · Cited by 115 · cited 1×
“Mechanisms of Recurrence Mechanisms of recurrence were reported in 5 studies.(16,17,19,21,22) In these 5 studies, 3 of which reported data exclusively from PAF patients, PV reconnection was noted in 417 of 423 patients who underwent repeat ablation; the rate of ≥1 PV reconnection was 97.”
Winkle, R. A., Mead, R. H., Engel, G., & Patrawala, R. A. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.04.013 · Cited by 92 · cited 1×
“Long-term single-procedure outcomes for longstanding persistent AF were reported in 3 studies,(17,23,27) but meta-analysis was not performed due to small numbers (<10 patients) of patients at late-term follow-up in 2 of these studies.(23,27) We specifically evaluated the impact of segmental compared with circumferenti…”
BackgroundKong, M. H., Piccini, J. P., & Bahnson, T. D. (2010) · EP Europace · doi:10.1093/europace/euq384 · Cited by 65 · cited 1×
“Comparisons to Previous Meta-analyses Over the years, a number of studies have addressed the shorter-term outcomes, predictors of recurrence,(28,29) or impact of specific types of ablation strategy.(35,36) The current study, for the first time, addresses the significant clinical issue of the long-term clinical outcome…”
ResultLong-term follow-up after radiofrequency catheter ablation for atrial fibrillation
Katritsis, D. G., Wood, M. A., Giazitzoglou, E., Shepard, R. K., Kourlaba, G., & Ellenbogen, K. A. (2008) · EP Europace · doi:10.1093/europace/eun018 · Cited by 64 · cited 1×
“Segmental PV isolation was used in 4 studies.(11,13,14,23) The stepwise ablation technique was the procedure of choice in 2 studies.”
MethodHunter, R. J., Berriman, T., Diab, I. G., Baker, V., Finlay, M., Richmond, L., Duncan, E. R., Kamdar, R., Thomas, G., Abrams, D. J., et al. (2010) · Heart · doi:10.1136/hrt.2009.188128 · Cited by 62
Fiala, M., Chovančík, J., Nevřalová, R., Neuwirth, R., Jiravský, O., Nykl, I., Škňouřil, L., Dorda, M., Januška, J., & Branny, M. (2008) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-008-9212-7 · Cited by 45
Characteristics of meta-analyses related to acceptance for publication in a medical journal
Stroup, D. F., Thacker, S. B., Olson, C. M., Glass, R. M., & Hutwagner, L. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00362-0 · Cited by 35 · cited 1×
“In recent years, however, meta-analysis has become accepted in the literature to aggregate results from observational data, to facilitate synthesis of available evidence and generation of new hypotheses.(37,38) In the case of AF ablation, the procedure is relatively new, with significant ongoing innovation in technolo…”
Matsuo, S., Yamane, T., Date, T., et al. (2010) · American Heart Journal · doi:10.1016/j.ahj.2010.10.016 · Cited by 28 · cited 2×
“Long-term single-procedure outcomes for longstanding persistent AF were reported in 3 studies,(17,23,27) but meta-analysis was not performed due to small numbers (<10 patients) of patients at late-term follow-up in 2 of these studies.(23,27) We specifically evaluated the impact of segmental compared with circumferenti…”
BackgroundMethodPratola, C., BALDO, E., Notarstefano, P., Toselli, T., & Ferrari, R. (2008) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e3280bad879 · Cited by 9 · cited 2×
“Six studies provided overall outcome data for mixed PAF/NPAF cohorts.(9,10,12,19,24,25) Study quality was assessed using a modified version of quality assessment criteria for case series.”
MethodThe "file drawer" phenomenon: suppressing clinical evidence.
(2004) · PubMed · Cited by 9
Sartini, R. J. P., Scanavacca, M., Sosa, E., Moreira, L. F. P., Lara, S., Hardy, C. A., Darrieux, F., & HACHUL, D. T. (2008) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2008000200008 · Cited by 7
Bunch, T. J., & DAY, J. D. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02117.x · Cited by 6
Research works printed but not linked: 1
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
“Most patients require more than one procedure to achieve symptom control.(713,726,728) In general, better rhythm outcome and lower procedure-related complications can be expected in younger patients with a short history of AF and frequent, short AF episodes in the absence of significant structural heart disease.”
InfluentialJoglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A. M., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 3,145
Calkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.012 · Cited by 2,794
Metadata
- 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
- Venue
- Journal of the American Heart Association
- Published
- 2013-03-12
- Volume
- 2
- Issue
- 2
- Pages
- e004549-e004549
- ISSN
- 2047-9980 (ISSN-L)
- 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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