Recurrence of Atrial Fibrillation After Repeat Catheter Ablation: A Systematic Review and Meta-Analysis

Catheter ablation is a key treatment for atrial fibrillation (AF); however, recurrence often requires repeat procedures. This meta-analysis evaluates the efficacy of repeat ablation for recurrent atrial arrhythmia, focusing on ablation technique, anatomical targets, and pulmonary vein (PV) reconnection.

A systematic literature search of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials was conducted on studies assessing repeat and initial ablation outcomes until February 2025. Data on atrial arrhythmia recurrence, ablation technique, targets, and PV reconnection were extracted. A random-effects model meta-analysis was used to estimate the pooled recurrence rate after repeat ablation.

Fifty-three studies (8,117 patients) were included. The recurrence rate after repeat ablation was 30% (95% confidence interval [CI]: 27%-34%), with PV reconnection observed in 90% of cases following the initial ablation. The lowest recurrence rate was observed with cryoballoon ablation (CBA) followed by radiofrequency ablation (RFA) at 23% (95% CI: 15%-33%, I² = 83%). Recurrence rates varied by strategy, with pulmonary vein isolation (PVI) alone resulting in a 25% recurrencerate (95% CI: 18%-35%, I² = 88.5%). PV reconnection rates also varied, with the left inferior PV (LIPV) showing the lowest rateat 23% (95% CI: 22%-24%, I² = 20.3%).

Repeat ablation for AF was associated with the risk of recurrence, mainly due to PV reconnection. Strategies involving CBA followed by RFA and PVI-based approaches showed favorable outcomes, while lower reconnection rates in left-sided PVs, especially the LIPV, highlighting the need for optimized techniques.