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Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-2514-5324
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.ORCID iD: 0000-0001-9019-4125
Venizeleio Gen Hosp, Greece.
Venizeleio Gen Hosp, Greece.
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2023 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 25, no 1, p. 40-48Article, review/survey (Refereed) Published
Abstract [en]

Aims The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF. Methods and results Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence. Conclusion Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion. Systematic review registration PROSPERO registry number: CRD42021270613.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2023. Vol. 25, no 1, p. 40-48
Keywords [en]
Catheter ablation; Atrial fibrillation; Umbrella review; Electrical cardioversion
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:liu:diva-188436DOI: 10.1093/europace/euac143ISI: 000846934400001PubMedID: 36037026Scopus ID: 2-s2.0-85147782905OAI: oai:DiVA.org:liu-188436DiVA, id: diva2:1695623
Available from: 2022-09-14 Created: 2022-09-14 Last updated: 2025-02-10

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Charitakis, EmmanouilDragioti, ElenaAlmroth, HenrikLiuba, IoanHassel Jönsson, AndersKarlsson, Lars
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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDivision of Prevention, Rehabilitation and Community MedicinePain and Rehabilitation Center
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