title: Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis.
abstract: BACKGROUND
  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.
  
  
  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 50mm (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 50mm and recurrence within 30 days, could be appraised to drive selection of patients and therapeutic strategy.
authors.affiliation: Divisione of Cardiology, University of Turin, Italy. fabrizio.dascenzo@gmail.com
authors.forename: F
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: A
authors.initials: A
authors.lastname: Corleto
authors.forename: G
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: M
authors.initials: M
authors.lastname: Anselmino
authors.forename: F
authors.initials: F
authors.lastname: Ferraris
authors.forename: L
authors.initials: L
authors.lastname: di Biase
authors.forename: A
authors.initials: A
authors.lastname: Natale
authors.forename: R J
authors.initials: RJ
authors.lastname: Hunter
authors.forename: R J
authors.initials: RJ
authors.lastname: Schilling
authors.forename: S
authors.initials: S
authors.lastname: Miyazaki
authors.forename: H
authors.initials: H
authors.lastname: Tada
authors.forename: K
authors.initials: K
authors.lastname: Aonuma
authors.forename: L
authors.initials: L
authors.lastname: Yenn-Jiang
authors.forename: H
authors.initials: H
authors.lastname: Tao
authors.forename: C
authors.initials: C
authors.lastname: Ma
authors.forename: D
authors.initials: D
authors.lastname: Packer
authors.forename: S
authors.initials: S
authors.lastname: Hammill
authors.forename: F
authors.initials: F
authors.lastname: Gaita
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000639:trends*; D017115:Catheter Ablation / Q000639:trends*; D006801:Humans; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D016896:Treatment Outcome