Catheter ablation in patients with atrial fibrillation and cancer: a systematic review and updated meta-analysis

Atrial fibrillation (AF) is common in cancer patients, and catheter ablation (CA) is a treatment option. However, outcomes of CA in cancer patients remain unclear.

To evaluate the outcomes of CA for AF in patients with a current or previous history of cancer compared to those without cancer, primarily focusing on bleeding, arrhythmia recurrence, repeat ablation, and mortality.

This systematic review and meta-analysis followed PRISMA guidelines. Data on bleeding, AF recurrence, repeat ablation, and mortality were pooled. Sensitivity analyses, meta-regression, and subgroup analyses explored factors influencing outcomes.

There were no randomized controlled trials (RCT). We included eight observational studies with 69,819 patients, of whom 68,913 were included in the primary outcome analysis. There was a non-significant trend toward increased clinically relevant bleeding within three months after CA in cancer patients compared to those without cancer (4.9% vs. 3.3%; OR 1.57; 95% CI 0.99-2.51; p = 0.056; I² = 24.1%). No significant differences were found in AF recurrence, the need for repeat ablation within 1 year, or mortality. Meta-regression indicated that prior oral anticoagulant use was not associated with a higher bleeding risk, while increasing age was associated with a higher risk of arrhythmia recurrence.

Compared to patients without cancer, CA for AF in cancer patients shows a trend toward higher bleeding risk, without statistical significance. RCT focused on cancer patients are needed to assess the safety and efficacy of AF treatments in this high-risk population.