Catheter and Surgical Ablation for Atrial Fibrillation : A Systematic Review and Meta-analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Atrial fibrillation ablation aims to restore normal heart rhythm.
• The impact of ablation on long-term clinical outcomes remains unclear.

Purpose of the Study:

• To evaluate the effect of catheter and surgical ablation on ischemic stroke risk occurring more than 30 days post-procedure.
• To assess the impact of ablation on other clinical outcomes, including mortality and heart failure hospitalizations.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials comparing ablation (catheter or surgical) with medical therapy.
• Searched multiple databases from 1987 to 2025, including bridge searches.
• Dual independent data extraction and risk-of-bias assessment were performed.

Main Results:

• Catheter ablation significantly reduced risks for ischemic stroke after 30 days (RR 0.63), mortality (RR 0.73), and heart failure hospitalizations (RR 0.68).
• Catheter ablation was associated with an increased risk of early ischemic stroke (at or before 30 days).
• Surgical ablation reduced risks for ischemic stroke (RR 0.54) and all-cause stroke, but its benefit for mortality and heart failure hospitalization was uncertain.

Conclusions:

• Catheter ablation is effective in reducing long-term risks of ischemic stroke, mortality, and heart failure hospitalizations.
• Surgical ablation shows a clear benefit in reducing stroke risk, with uncertain benefits for other outcomes.
• Further research may be needed to clarify the overall risk-benefit profile of different ablation strategies.