Atrial Fibrillation Termination as a Predictor for Persistent Atrial Fibrillation Ablation: A Systemic Review and Meta-Analysis of Prospective Studies

Background: In this systematic review and meta-analysis, we aimed to validate the predictive role of atrial fibrillation (AF) termination in long-term arrhythmia recurrence.

Method: Our search encompassed databases including MEDLINE, EMBASE, PubMed, and the Cochrane Library up to August 1, 2021. Three independent reviewers conducted screening and data extraction. The data included ablation strategy, recurrence mode, AF termination mode, numbers of patients, and recurrence cases in the termination and nontermination groups. The primary endpoint was the recurrence of atrial arrhythmia at long-term follow-up (≥ 12 months).

Results: Our analysis included 22 publications, with 11 prospective studies being eligible for further meta-analysis. Among these, 14 studies reported significantly lower rates of arrhythmia recurrence in the AF termination group compared to the nontermination group. Among seven studies involving 1114 patients that examined single procedure outcomes, the pooled estimated effect was RR 0.78 (95% CI 0.68–1.90) with an I² value of 57%. Subgroup analysis focusing on termination mode as sinus rhythm yielded a pooled estimated effect of RR 0.74 (95% CI 0.59–0.92) with an I² value of 47%. Additionally, analysis of seven studies involving 1433 patients for repeat procedures demonstrated a significant preference for the AF termination group (RR 0.83, 95% CI 0.71–0.97, I² = 84%). Subgroup analysis indicated reduced heterogeneity when the termination mode was sinus rhythm (RR 0.68, 95% CI 0.51–0.90, I² = 57%).

Conclusion: Our study establishes that AF termination serves as an effective predictor for the success of persistent AF ablation procedures. This finding holds potential implications for clinical practice and contributes to our understanding of long-term arrhythmia recurrence in the context of AF termination.